Shingles is a viral infection caused by varicella zoster, the same virus that causes chicken pox. Anyone who has had chicken pox can get shingles since the virus stays inactive in the body’s nerve tissue and can re-emerge later. The Centers for Disease Control (CDC) estimates that about 1 million Americans get shingles each year, and that half of all shingles cases occur in people 60 years or older.
While anyone with a history of chickenpox can get shingles (even children), it is most common among people over 50 and those with weakened immune systems due to cancer, HIV/AIDS and other conditions. Taking certain medications, such as chemotherapy for cancer, steroids, and those drugs used to prevent rejection of transplanted organs, can increase the risk of developing shingles. Asthma is under study as a potential risk factor for developing shingles.
Shingles can occur anywhere on the body though it often appears as a stripe of painful blisters on one side of the torso. The symptoms might include pain, burning, numbness or tingling, sensitivity to touch, a rash of fluid-filled blisters, itching, fever, headache and fatigue. Some people develop the rash around an eye or on the neck or face while others may experience the pain of shingles without a rash.
The Shingles Virus
Shingles, or varicella zoster, is a member of a group of viruses called herpes viruses, which include the viruses that cause cold sores and genital herpes. This is why shingles is also sometimes called herpes zoster. Chicken pox and shingles, however, are not caused by the same virus responsible for herpes simples types 1 and 2, cold sores and genital herpes (a sexually transmitted disease).
A shingles rash typically lasts two to four weeks. While shingles is seldom life threatening, it can be very painful. For 1 in 5 shingles sufferers, nerve pain called post-herpetic neuralgia (PHN) can last long after the rash has cleared. Shingles is treated with anti-viral medications (e.g. acyclovir, valacyclovir and famciclovir), which are best started soon after symptoms appear. If shingles go untreated, more serious complications can occur, such as vision and hearing loss, brain inflammation and pneumonia.
A person with shingles can pass the virus through contact with the open rash sores to anyone who hasn’t had chicken pox, however, the person will get chickenpox, not shingles. Until blisters scab over, it is best to avoid contact with pregnant women, infants and people with compromised immune systems if they haven’t had chickenpox. The only way to reduce the risk of developing shingles and its possible complications is to get vaccinated. While the vaccine is not a guarantee, the CDC reports that it reduces the risk of getting shingles by 51% and nerve pain by 67%.
The Shingles Vaccine
The Food and Drug Administration (FDA) approved the shingles vaccine called Zostavax for people 50 and older. It has been used since 2006 and is given at doctor’s offices and pharmacies. The CDC recommends that people 60 years and older get the vaccine, since rates of disease are lower among people in their 50s and increase as they enter their 60s. The vaccine offers protection for about 5 years so adults vaccinated before they are 60 years old might not be protected later in life when the risk for shingles is greater. Currently, there is no booster for the vaccine so it is considered a one-time vaccination, and its effectiveness after 5 years is uncertain.
In a study about effectiveness, the FDA reported that Zostavax was most effective (64%) in reducing the occurrence of shingles in people between 60 and 69. It was 41% effective for the 70-79 age group and 18% effective for those 80 and older. Among people who received the vaccine, but still got shingles, the pain lasted for fewer days than it did for those who didn’t receive it.
Having shingles boosts your immunity to the virus and may help protect you from getting shingles again. The odds of re-occurrence are small but those at higher risk are people who suffered from severe PHN, women, being over 50 with the first episode, or having a weak immune system. The clinical trials for the vaccine did not establish the effectiveness of the vaccine for preventing repeated episodes, but according to the Mayo Clinic, it is recommended for people 60 and over whether they have had shingles already or not. The vaccine is also recommended for people even if they do not recall having had chickenpox. According to studies referenced by the CDC, 99% of Americans aged 40 and older have had chickenpox.
Who Should Not Receive the Shingles Vaccine
It is important to discuss the safety of receiving the shingles vaccine with your provider, but special caution is recommended for people who:
- Are allergic to gelatin, neomycin or any of the ingredients in the vaccine. Discuss all allergies with your provider.
- Are or may be pregnant, and those in close contact with pregnant women who have not had chickenpox.
- Have a weakened immune system.
- Under 50 years. Zostavax is not approved for children and should not be substituted for the chicken pox vaccine, Varivax.
- Have a moderate or severe illness. This includes having a temperature of 101.3°F or higher.
Cost and Coverage
The shingles vaccine costs about $200. If you are thinking of having the vaccine, call your insurance company first to find out if it is covered. Many insurers do not classify the vaccine as preventive care, and it may not be covered. Medicare Part B does not cover the vaccine and Medicare Part D may cover part of the cost; Medicaid may cover it but it depends on the insurer. Many private insurers cover it for people 60 and older, and some cover it for people 50-59. Merck, the pharmaceutical company that makes Zostavax, offers a patient assistance program that provides free vaccines for eligible adults.
Deciding to have the shingles vaccine depends on a number of issues: your age, current health status, health history, and affordability. As with all important healthcare decisions, discuss your options with your provider. Your KnovaSolutions clinician is available to provide information and help you make a decision that is right for you. Call 800/355-0885.
Click here to view/download the full newsletter.
We encourage you to leave a comment or question below and a KnovaSolutions nurse or pharmacist will reply.
The information contained in this newsletter is for general, educational purposes. It should not be considered a replacement for consultation with your healthcare provider. If you have concerns about your health, please contact your healthcare provider.