If you have had chickenpox and are aged 50 years old and above, you are at risk for shingles. But what is it, and why should you be worried about it?
Shingles, what’s that?
Spelled ‘single’ with an ‘h’, shingles is a nerve and skin disease caused by the varicella zoster virus (VZV), the same virus that causes chickenpox. It is also known as the ‘snake’ in local vernacular, or ‘penyakit kayap’ in Malay language.
After a person recovers from chickenpox, the virus stays ‘asleep’ in their body. The virus can reactivate later due to reasons we will discuss later and causing shingles.
Sounds interesting, right? The exact same virus that causes chickenpox can lead to an entirely different disease when reactivated in the same body.
Most people who develop shingles have only one episode during their lifetime. However, you can have shingles more than once. In the United States, about 1 in every 3 people will develop shingles.
Believe us, you wouldn’t want to get shingles
Because it can be an extremely painful viral infection for some people. After your chickenpox is resolved, the virus goes to ‘sleep mode’ in your dorsal root ganglia, a part of the nervous system. Once reactivated, it can lead to the following signs and symptoms:
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Pain, itching or tingling in some parts of the body a few days prior to the development of rashes.
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Painful rash that develops on one side of the face or body. The rash consists of blisters that typically scab over in 7 to 10 days and fully clears up within 2 to 4 weeks.
The rash typically occurs in a single stripe around either the left or the right side of the body, which is probably why Malaysians refer to shingles as ‘snakes’ in colloquial terms.
Image credit: MyHealth - Shingles.
Alternatively, the rash can occur on one side of the face , which may affect the eye and cause vision loss. In rare cases (usually in people with weakened immune systems), the rash may be more widespread on the body and look similar to a chickenpox rash. Other discomforts of shingles are similar to other viral infections, which include fever, headache, chills and upset stomach.
I have never had chickenpox, will I get shingles from someone with shingles?
Image credit: https://www.nfid.org/infectious-diseases/chickenpox-varicella/
You cannot get shingles from someone who has shingles, regardless of whether you have developed chickenpox before. However, you can get chickenpox from someone who has shingles through direct contact with the fluid from the rash blisters if you never had chickenpox or never received the chickenpox vaccine. You could then develop shingles later in life.
If you have shingles, you can minimize the risk of spreading the virus to others by doing the following:
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Covering the shingles rash. People with shingles cannot spread the virus before their rash blisters appear or after the rash crusts.
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Avoid touching or scratching the rash.
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Wash your hands often with soap and water.
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Avoid contact with the following people until your rash crusts:
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pregnant women who have never had chickenpox or the chickenpox vaccine;
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premature or low birth weight infants; and
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people with weakened immune systems, such as people receiving immunosuppressive medications or undergoing chemotherapy and/or corticosteroids treatment, organ transplant recipients, and people with human immunodeficiency virus (HIV) infection.
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💡 Fun fact: People with chickenpox are more likely to spread VZV than people with shingles.
The ‘awakening’ of varicella zoster virus
John Pozniak, with zoster blisters on his neck and shoulder. Taken May 5, 2006, in San Jose, California, United States. Copyright © 2006, John Pozniak, and released under the terms of the GNU Free Documentation License ver. 1.2 or any later version.
Shingles, although caused by a virus, is not really a viral infection, at least in the conventional sense. As we discussed earlier, you can’t really catch shingles from another person (but you can catch chickenpox from infected persons), as it is the reactivation of the virus itself in your own nervous system. Its development heavily hinges on your immune status. The following, however, can increase your risk of developing shingles:
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50 years old and above. This is the most important risk factor for the development of shingles. The severity of the disease and chances of developing nasty complications are also increased with age.
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A weakened immunity, i.e. anyone who is receiving immunosuppressive medications or undergoing chemotherapy and/or corticosteroids treatment, organ transplantation and HIV infection.
Long-term nerve pain, or postherpetic neuralgia (PHN), is the most common complication of shingles. PHN occurs in the areas where the shingles rash was, even after the rash clears up. It can last for months or years after the rash goes away. The pain from PHN can be so severe and debilitating that it interferes with daily life. Something to take note of: an older adult with shingles is more likely to develop PHN and have longer lasting and more severe pain than a younger person with shingles. Other nasty complications of shingles include:
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Blindness
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Hearing problems
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Pneumonia
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Brain inflammation (encephalitis), or
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Death
Fortunately, the vaccine for shingles, called herpes-zoster vaccine, is available around the world.
The herpes zoster vaccine
One of the herpes zoster vaccines, Zostavax®, was launched by Merck, Sharpe and Dohme in Malaysia in November 2013.
Image credit: https://www.mims.com/thailand/drug/info/zostavax
Zostavax® contains a live but weakened version of the varicella zoster virus. After injecting this vaccine, it tricks your immunity into thinking that it is infected by the virus, thus producing an army of immune cells that specifically targets the virus -- all takes place without subjecting your body to the painful experience of an actual shingles.
Zostavax® is recommended to the following populations:
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Patients ≥60 years of age including patients who report a previous episode of chickenpox.
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Patients without a history of chickenpox can also receive the vaccine.
Nevertheless, like the rest of medications and vaccines, Zostavax® may not be warranted or even suitable in certain populations. Talk to your doctor for further information.
Treatment of shingles
Several antiviral medicines—acyclovir, valacyclovir, and famciclovir—are available to treat shingles and shorten the length and severity of shingles. These medicines are most effective if you start taking them as soon as possible after the rash appears. If you think you have shingles, consult a healthcare provider as soon as possible to discuss treatment.
Pain medicine, either over-the-counter or a prescription from your doctor, may help relieve the pain caused by shingles. Wet compresses, calamine lotion, and colloidal oatmeal baths (a lukewarm bath mixed with ground up oatmeal) may help relieve itching.
References
Cover image credit: John Pozniak, with zoster blisters on his neck and shoulder. Taken May 5, 2006, in San Jose, California, United States. Copyright ©2006, John Pozniak, and released under the terms of the GNU Free Documentation License ver. 1.2 or any later version.
