Shingles is one of those dreaded conditions that you may not think too much about—until it’s your turn to endure the ravages of this painful viral infection.
Recent development: There’s a new vaccine that provides better protection than the previous one. But despite all the attention it’s getting, many people are still unaware of some key details.
Reality check: Because some people—vaccinated or not—still do develop shingles, you also need to know how to best treat the condition and use self-care measures to curb the suffering.
THE SHINGLES VACCINE
The first vaccine for adult shingles, Zostavax, was FDA approved in 2006. It was found to prevent shingles in about half of people who received the single shot.
What you may not realize: Shingles is much more than a skin rash. It’s a viral infection that starts with a rash but usually doesn’t stop there. The rash can be intensely painful and can lead to severe nerve pain that’s potentially permanent. And in some cases, shingles can increase stroke risk.
Shingrix, the shingles vaccine that was FDA approved in late 2017, is about 97% effective against shingles during the first year. Its effectiveness wanes over time, but experts predict that it will continue to reduce infections by about 85% over four years. Research has shown that it’s particularly effective in older adults, who face the highest risk for shingles.
What you may not realize: The new vaccine is also recommended for those who were previously vaccinated with Zostavax. Even if you’ve already received the older vaccine, the CDC recommends getting the new one. Also important: Just because you’ve already had shingles, it doesn’t mean you’re off the hook—you can get shingles more than once. Other key facts to know about the new vaccine…
• It requires two doses instead of one. While the original shingles vaccine was given in a single dose, Shingrix requires two doses—given about two to six months apart.
• It’s pricey. Shingrix is about $280 for both shots total, roughly the same cost as the single-shot original vaccine. Most insurance, including Medicare, is expected to cover the new vaccine, but you’ll want to check before getting the shots.
• There’s some discomfort from the shot, which involves mainly arm swelling and localized pain—this is typical with most injections. But about half of patients age 70 and older report more bothersome side effects, including widespread muscle pain, fatigue and/or headaches. Most side effects are temporary and last about 24 to 48 hours.
• The vaccine’s duration is uncertain. Most vaccines lose their protection over time. The older shingles vaccine seems to lose some of its protection after about five or six years. Shingrix has not been used long enough to determine exactly how many years of protection it will give. And patients may need revaccination at some point after the original vaccination series.
• Shingrix uses killed viruses, while Zostavax uses live viruses. Those with impaired immune systems cannot receive live vaccines. If you have been told in the past that you cannot get the shingles vaccine due to an impaired immune system, ask your doctor about Shingrix.
• Shingrix can be given starting at age 50, while Zostavax was given to those age 60 and older.
My advice: Everyone age 50 or older and any adult with an impaired immune system should ask a doctor about getting the new vaccine.
IF YOU DO GET SHINGLES
If you get vaccinated but develop shingles anyway, the rash will typically be milder with less severe pain, and the illness will be shorter in duration. Plus, there will be less risk for serious complications such as permanent nerve damage.
Shingles typically starts with one to five days of shooting or burning pain, numbness, tingling, itching and/or skin sensitivity. Some people also have flulike symptoms—headache, chills and fever. The affected skin will then develop redness and small blisters filled with fluid. If you get these symptoms, see your doctor right away—early diagnosis and treatment can help shorten the course of the attack and improve symptoms. Antiviral medication may shorten the duration of the illness and help with pain relief. It also can reduce risk for nerve pain complications but must be given soon after the rash appears, ideally within 72 hours.
If the pain is severe: Ask your doctor about gabapentin (Neurontin), an antiseizure drug that also relieves nerve pain. Topical lidocaine, available over-the-counter, can help with pain as well.
Complications: The shingles rash sometimes occurs on the face or near the eyes. In these cases, the virus can enter the optic nerve and cause vision loss. And in very rare cases, the shingles virus can infect the brain and cause inflammation of the brain (encephalitis). Important: Seek immediate medical care if the rash is near your eye or on your nose or it continues spreading to other parts of your body.
Best self-care options…
• Try a cool-water compress…or oatmeal/baking soda baths, which can reduce itching and discomfort. For a compress, soak and wring out a soft washcloth with cool water and apply it to the rash for five to 10 minutes, several times per day. For baths, add colloidal oatmeal/baking soda to cool bathwater. Soak for 10 minutes once a day.
• Coat the rash with a thick ointment such as petroleum jelly, Aquaphor or unscented A&D Ointment, then cover the area with a bandage. Ointments are soothing, and the bandage will protect the area from the friction caused by clothing.
• Wear loose, natural-fiber clothes (such as cotton). They’re more comfortable than polyester or other synthetic fabrics.
THE SHINGLES TRAP
About 90% of adults had chicken pox (varicella-zoster virus) early in life. Once you’ve been exposed to this virus, it retreats to the nervous system and lies dormant. The virus can reactivate later in life, usually after age 50, and cause shingles.
Sometimes shingles will be reactivated during periods of extreme stress on the body—for example, during a bad illness. People with weakened immune systems—the elderly…those with chronic diseases…and/or patients taking immune-suppressing medications for conditions such as rheumatoid arthritis or lupus or using chemotherapy drugs—are at greater risk of developing shingles.