First of all, if you've never had chicken pox, you are safe from shingles, but more on that later. Shingles is a localized infection caused by the same varicella-zoster virus (VZV) that led to chicken pox. Once you have recovered from chicken pox, usually as a child, the virus stays in the body, lying dormant in certain nerve cells causing no problems or symptoms. At some point, likely due to a weakened immunity system, the virus can reactivate. It multiplies along nerve fibers just under the skin which leads to fluid-filled blisters in a rash called shingles.
The VZ virus can lay dormant forever, but for about 20 per cent of people who have had chicken pox, it will reactivate. Though it can afflict anyone, it occurs most often in older people. Shingles itself is not contagious. That is, you can’t pass on ‘shingles’ per se, but it can infect someone who has not already had chicken pox with that disease. Most people who get shingles will get better and will not get it again. But it is possible to get shingles more than once.
The first signs of shingles are usually tingling or a burning pain in an area supplied by infected nerves. This will occur three to four days ahead of a rash which looks, unsurprisingly, just like chicken pox. Small blisters containing the virus form from the rash and last two to three weeks. Shingles can appear in many places on the body; blisters commonly show up on the face or trunk, and may occur on the buttocks or genitals.
Severe pain is the most significant effect of shingles, and it can last several months or longer. Postherpetic neuralgia (PHN) is pain, headaches and nerve problems that occur as a complication of shingles. PHN lasts for at least 30 days but can continue for months, or years.
Treatment for shingles is focused on pain-reduction and limiting secondary infection. One of the best treatments is to start antiviral medicines within the first 72 hours after the appearance of the rash. This will clear up the rash and reduce the risk of PHN. For shingles, standard pain killers are often not very effective, so other strategies may be used. These include anti-inflammatories, Capsaicin, Aspirin cream or Lidocaine. Steroid injections and nerve blocks have also been used.
The most effective way to avoid shingles is to never have had chicken pox. It may be too late for an adult, but children are protected with their routine childhood vaccinations. A second option is a shingles vaccine. This lowers the risk for shingles and can prevent long-term pain after shingles. The Shingrix vaccine provides 97% protection in the 50 – 69 age group and 91% protection in the over 70 age group. Shingrix is now available at the VCH Travel Clinic. Shingrix will be given as 2 doses 2-6 months apart at a cost of $150 per dose.
And for any adult not immunized against chicken pox, the varicella vaccine is definitely recommended.
Chicken pox may have been a childhood disease common in many people’s lives, but it need not be the case for today’s children. Not only can a child today avoid chicken pox, he or she will also benefit by not being subject to shingles in later life.
Written by Dr. Paul Martiquet, Medical Health Officer for Rural Vancouver Coastal Health including Powell River, the Sunshine Coast, Sea-to-Sky, Bella Bella and Bella Coola.