SIMPLY HEALTH: The Dread of Creeping Girdle

posted 12/29/2008
The word "shingles" strikes a shudder of fear into the heart of many, even those who have little knowledge about it. Herpes zoster, named by the Greek physician Hippocrates, has plagued mankind for millennia. The name describes the creeping (herpes) rash that wraps like a girdle (zoster), most often around one side of the torso. Shingles, the Latin word for girdle, seems to have been the common name that stuck. Nearly 2500 years later, we have a vaccine to diminish the scourge of this painful disease.

After the initial chickenpox infection in childhood, the varicella-zoster virus lies dormant and quiet at the nerve roots along the spine, usually for decades. When our immune system is weakened by disease, cancer treatment, stress, or aging, the virus re-activates at a given nerve root and travels along the nerve pathway to the skin, erupting into a blistering, painful rash on one side of the body. If the affected nerve supplies the face, it can sometimes involve the cornea of the eye and lead to blindness. Aching, fever and a burning sensation on the skin may precede development of the rash.

The rash arises over a period of days and may last for several weeks to a month. The virus is contagious while the lesions are in the open, weeping stage, until they have dried. Antiviral medications are given to diminish the severity and duration of the outbreak. Keeping the rash dry is important and strong black tea compresses or calamine lotion can be soothing. Narcotics may be necessary to control pain. About one in five persons develop persistent painful inflammation of the nerve called post-herpetic neuralgia, which can last up to a year or longer.

Nearly all adults have antibodies to the varicella-zoster virus from childhood exposure to the chickenpox. The subsequent lifetime risk for developing herpes zoster is 15-30%. That risk rises as we age. Of those over sixty years of age who develop shingles, persistent residual nerve pain occurs in about 40% percent.

Who Gets Shingles?

Those with chickenpox as a child
One in ten of those over age 60
Nearly half of those over age 80
Risk is higher if the immune system is compromised
40% of those over age 60 develop persistent nerve pain

There are close to one million cases of herpes zoster every year in the U.S. Although more than half of these cases occur after middle age, shingles is occasionally seen in children and young adults. In rare cases, it can be a severe disease affecting the central nervous system causing meningitis, paralysis or encephalitis.

Zostavax was released by the FDA (Food and Drug Administration) for use in adults 60 years and older in 2006. The single-dose vaccine is covered by Medicare and some insurance companies. Unlike other vaccines such as the flu shot and pneumonia vaccine, Zostavax is covered by Medicare part D as a medication. It is prescribed and administered by your health care provider, but you need to obtain it from the pharmacy first. It must be stored frozen and used within 30 minutes of thaw. The vaccine does not contain the preservative thimerosal. Side effects are very mild and generally limited to injection site tenderness and headache.

About Zostavax

Approved for age 60 and over
A single dose vaccine
Lowers rate of shingles by 50%
Reduces post-herpetic neuralgia by 67%
Very mild side effects
Contains no thimerosal
Covered by Medicare Part D

So if most all adults have been exposed to the varicella-zoster virus, what good is the vaccine? The vaccine has been shown to reduce the incidence of developing shingles by over 50 percent and more importantly, reduces the incidence of severe post-herpetic neuralgia by 67 percent.

What if you have already had shingles? The risk of having a recurrence of shingles is about 5 percent and the vaccine only reduces that risk to 4 percent, so if you have had shingles, vaccination is not particularly helpful. Recurrence is most common among those who are in some way immune - compromised or who are HIV positive.

Avoid the vaccine if you are pregnant, are allergic to neomycin or gelatin, are undergoing radiation or chemotherapy, have HIV infection, leukemia or lymphoma, or are on immunosuppressive drugs for other conditions.

At the other end of the age spectrum, the vaccine Varivax has been given to young children to prevent chickenpox infection since 1995. As these children move into adulthood, the threat of shingles will likely decrease.

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