"I was having exams at college and I got a rash in a band around one side of my waist. The spots were very painful. At first I thought it was chickenpox, but I'd had that years before," recalls a young woman who had shingles in her twenties.
The young woman's memory was correct. She did have chickenpox as a child. You cannot develop shingles unless you have had an earlier exposure to chickenpox, and most people who get chickenpox are at risk for shingles. The woman had the typical one-sided band of rash and pain of this common neurological disorder. Her age was unusual, however.
While young people do develop shingles, the disease most often strikes after age 40. But since shingles is so common, affecting an estimated one-quarter of Americans at some point during their lifetimes, cases in young people are not rare.
Scientists
call the virus that causes chickenpox/shingles
varicella-zoster
virus or VZV. The word "varicella" is derived from "variola," the
Latin word for smallpox, another infectious disease that
can resemble chickenpox. (Smallpox is a highly contagious
and often fatal disease that has disfigured or killed millions
of people, especially during the Middle Ages.) “Zoster” is
the Greek word for girdle; shingles often produces a girdle
or belt of blisters or lesions around one side of the waist.
This striking pattern also underlies the condition's common
name: shingles comes from “cingulum,” the Latin
word for belt or girdle.
VZV belongs to a group of viruses called herpesviruses.
This group includes the herpes simplex virus that
causes cold sores, fever blisters, mononucleosis, genital
herpes (a sexually transmitted disease), and Epstein-Barr
virus involved in infectious mononucleosis. Like VZV,
other herpesviruses can hide in the nervous system after
an initial infection and then travel down nerve cell
fibers to cause a renewed infection. Repeated episodes
of cold sores on the lips are the most common example.
As early as 1909, scientists suspected that the viruses
causing chickenpox and shingles were one and the same.
In the 1920s and 1930s, the case was strengthened by an
experiment in which children were inoculated with fluid
from shingles blisters. Within 2 weeks, about half of the
children developed chickenpox. Finally, in 1958, detailed
analyses of the viruses taken from patients with either
chickenpox or shingles confirmed that the viruses were
identical.
Virtually all adults in the United States have had chickenpox,
even if it was so mild as to pass unnoticed, and thus may
develop shingles later in life. In the original exposure
to VZV (chickenpox), some of the virus particles leave
the blood and settle into clusters of nerve cells (neurons )
called sensory ganglia, where they remain for many years
in an inactive (latent) form. The sensory ganglia,
which are adjacent to the spinal cord and brain, relay
information to the brain about what the body is sensing
- heat, cold, touch, pain.
When the VZV reactivates, it spreads down the long nerve
fibers (axons) that extend from the sensory cell bodies
to the skin. The viruses multiply, the telltale rash erupts,
and the person now has herpes zoster, or shingles. With
shingles, the nervous system is more deeply involved than
it was during the bout with chickenpox, and the symptoms
are often more complex and severe.
Who is at Risk for Shingles?
About 25 percent of all adults, mostly otherwise healthy,
will get shingles during their lifetimes, usually after
age 40. The incidence increases with age so that shingles
is 10 times more likely to occur in adults over 60 than
in children under 10. People with compromised immune
systems - from use of immunosuppressive medications such
as prednisone, from serious illnesses such as cancer,
or from infection with HIV - are at special risk of developing
shingles. These individuals also can have re-eruptions
and some may have shingles that never heals. Most people
who get shingles re-boost their immunity to VZV and will
not get the disease for another few decades.
Youngsters whose mothers had chickenpox late in pregnancy
- 5 to 21 days before giving birth - or who had chickenpox
in infancy, have increased risk of pediatric shingles.
Sometimes these children are born with chickenpox or
develop a typical case within a few days
What are the Symptoms of
Shingles?
The first sign of shingles is often burning or tingling
pain, or itch, in one particular location on only one
side of the body. After several days or a week, a rash
of fluid-filled blisters, similar to chickenpox, appears
in one area on one side of the body. Recent studies have
shown that subtle cases of shingles with only a few lesions,
or none, are more common than previously thought. These
cases will usually remain unrecognized. Cases without
any known lesions are known as zoster sine herpete.
Shingles pain can be mild or intense. Some people have
mostly itching; some feel pain from the gentlest touch
or breeze. The most common location for shingles is a
band, called a dermatome, spanning one side of the trunk
around the waistline. The second most common location
is on one side of the face around the eye and on the
forehead. However shingles can involve any part of the
body. The number of lesions is variable. Some rashes
coalesce and produce an area that looks like a severe
burn. Other patients may have just a few scattered lesions
that don't cause severe symptoms.
For most healthy people, shingles rashes heal within
a few weeks, the pain and itch that accompany the lesions
subside, and the blisters leave no scars. Other people
may have sensory symptoms that linger for a few months.
How Should Shingles Be
Treated?
Shingles attacks can be made less severe and shorter
by using prescription antiviral drugs: acyclovir,
valacyclovir, or famcyclovir. Acyclovir is available
in a generic form, but the pills must be taken five times
a day, whereas valacyclovir and famcyclovir pills are
taken three times a day. It is important not to miss
any doses and not to stop taking the medication early.
Antiviral drugs can reduce by about half the risk of
being left with postherpetic neuralgia,
which is chronic pain that can last for months or years
after the shingles rash clears. Doctors recommend starting
antiviral drugs at the first sign of the shingles rash,
or even if the telltale symptoms indicate that a rash
is about to erupt. Even if a patient is not seen by a
doctor at the beginning of the illness, it may still
be useful to start antiviral medications if new lesions
are still forming. Other treatments to consider are anti-inflammatory
corticosteroids such as prednisone. These are
routinely used when the eye or other facial nerves are
affected.
Is Shingles Contagious?
A person with a shingles rash can pass the virus to
someone, usually a child, who has never had chickenpox,
but the child will develop chickenpox, not shingles.
A person with chickenpox cannot communicate shingles
to someone else. Shingles comes from the virus hiding
inside the person's body, not from an outside source.
Can Shingles Be Prevented?
Chickenpox vaccine
Immunization with the varicella vaccine (or chickenpox
vaccine) - now recommended in the United States for all
children between 18 months and adolescence - can protect
children from getting chickenpox. People who have been
vaccinated against chickenpox are less likely to get
shingles because the weak, “attenuated” strain
of virus used in the chickenpox vaccine is less likely
to survive in the body over decades.
Some scientists believe that immunizing children against
chickenpox increases the risk of shingles in adults who
were not themselves immunized during childhood. This
is because when adults care for children sick with chickenpox,
it reboosts their own immunity that keeps their own virus
from reactivating as shingles. With fewer children coming
down with chickenpox, there are fewer opportunities for
this "reboosting" of adult immunity, and so there may
be more shingles cases for the next 40-50 years.
Shingles vaccine
In May 2006, the Food and Drug Administration approved
a VZV vaccine (Zostavax) for use in people 60 and older
who have had chickenpox. When the vaccine becomes more
widely available, many older adults will for the first
time have a means of preventing shingles.
Researchers found that giving older adults the vaccine
reduced the expected number of cases of shingles by half.
And in people who still got the disease despite immunization,
the severity and complications of shingles were dramatically
reduced. The Shingles Prevention Study -
a collaboration between the Department of Veterans Affairs,
the National Institute of Allergy and Infectious Diseases,
and Merck & Co., Inc. - involved more than 38,000
veterans aged 60 and older. The purpose was to find out
how safe the vaccine is, and if it can prevent shingles.
Half the study participants were vaccinated with a more
potent version of the chickenpox vaccine, developed specifically
for use in adults, and half received a placebo vaccine.
Neither volunteers nor researchers knew a particular
subject had gotten active or placebo vaccine until after
the end of the study (a double-blind study).
During more than 3 years of followup, the vaccine reduced
shingles cases by 51 percent; 642 cases of shingles developed
in the placebo group compared with only 315 in the vaccinated
group. Pain and discomfort were reduced by 61 percent
In people who received the active vaccine but still got
shingles. The vaccine also reduced the number of cases
of postherpetic neuralgia by two-thirds compared with
the placebo.
The shingles vaccine is only a preventive therapy and
it is not a treatment for those who already have shingles
or postherpetic neuralgia.
To read the rest of this article from the National Institute
of Neurological Disorders and Stroke, please click here:
http://www.ninds.nih.gov/disorders/shingles/detail_shingles.htm
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