If you ask someone who has experienced shingles to describe what it felt like, the answer is likely to be “horrible, searing pain.”
Clearly, that’s not a sensation most of us would want to experience, but once shingles (also known as herpes zoster) has broken out, there is a limit to what can be done to alleviate the pain.
The good news is that there is a vaccine that can prevent 51 per cent of shingles cases, and for people who have been vaccinated but still experience a breakout, the vaccine can make their symptoms less severe.
Dr. Shelly McNeil is a professor of medicine in the division of infectious diseases at Dalhousie University and an infectious disease consultant at the QEII Health Sciences Centre in Halifax. She points out that, for the 95 per cent of Canadians who had chicken pox as a child, the virus, called varicella zoster, remains in their nerve roots. “It can live in the nerve roots for years and cause no problems at all, since the initial case of chicken pox provided some antibodies to keep the virus in check,” she says.
People under the age of 50 rarely get shingles. However, as people get older, immunity to the virus decreases and if they have medical treatments (such as those for cancer) that employ strong drugs that suppress the immune system, the immune system may not be able to control the virus, and a case of shingles can break out.
A painful, blistering skin rash is the visible sign of shingles. It can occur on any part of the body, but appears most commonly on the trunk. “Shingles almost never crosses the midline,” says Dr. McNeil, “because nerves come out from the spine and go either right or left. If you draw a line down the middle of the patient, the shingles would be all on one side.” This characteristic helps with the diagnosis, but shingles can also occur on the extremities or on the face, and can affect the nerve that supplies the eye or even the eye itself.>
While the rash usually resolves in two weeks, there is a less visible and more serious side of shingles. “One of the most common and dreaded complications of shingles is called post-herpetic neuralgia,” says Dr. McNeil. “This is a chronic pain syndrome of the area of skin affected by shingles. It is related to the inflammation in the nerve root that can cause quite severe pain and can last from three months to a number of years after the rash resolves.”
That chronic pain is difficult to treat. Acetaminophen and ibuprofen are ineffective; even narcotic painkillers often don’t provide relief. “We use some fancy drugs that are used more for nerve-type pain, like gabapentin or similar drugs, but they are poorly tolerated and they are expensive,” says Dr. McNeil. The chances of developing post-herpetic neuralgia with shingles goes up with age; about 50 per cent of people who get shingles after age 70 will develop chronic pain.
Shingles affects one in five people in Canada, but only a small percentage of those who could benefit from the vaccine actually get vaccinated, either because they are not aware that they are vulnerable to the condition, they are not aware that the vaccine exists, or because the vaccine costs close to $200, and it is not publicly funded anywhere in Canada.
The vaccine is not given to people with compromised immune systems and is not given to people during an outbreak of shingles, but the National Advisory Committee on Immunization recommends that everyone else 60 years or older get vaccinated.
Currently, the vaccine is given only once in a lifetime, but Dr. McNeil says there may be data in future to support giving booster shots.
Recent data show that the vaccine protects for at least eight years, which explains why medical professionals hesitate to give the vaccine to younger people—it could become ineffective by the time the individual reaches the age when shingles poses more of a threat.
“Shingles is a common problem that can be quite debilitating for older people,” says Dr. McNeil.
“But, usually, shingles is not life threatening. Most people experience two to four weeks of this pain, rash and discomfort, and then it resolves.”