What is shingles?

Shingles arises from the re-activation of varicella-zoster virus (VZV), the culprit of chicken pox, which normally lies dormant for many years and decades within the nervous system. The virus breaks out of nerve cell bodies and travels down the axons to cause a viral infection at the skin of the dermatome. As a result, this leads to local inflammation, rash, blistering  and nerve pain.

This re-activation occurs more commonly in the elderly, immunocompromised, those under psychological stress, or due to other potential factors (e.g. mechanical trauma, etc…).  Believe it or not, about 10-30% develop shingles in one’s lifetime and this increases put to 50% by age 85; this is likely due to the reduction in the immune system as a part of aging.

So how do you know if you have shingles? What are the complications?

In the earliest phase, one will develop non-specific symptoms, which include things like headache, fever and malaise; this is followed by burning pain, itching, oversensitivity and “pins and needles”. The burning pain may be mild to extreme, with sensations often described as stinging, tingling, numbing, throbbing, aching, interspersed with quick stabs of agonizing pain prior to the rash.

After 1-2 days or up to 3 weeks later, a painful skin rash may appear. It’s characteristics will include a stripe or belt-like pattern affecting only one side of the body. This rash is most commonly found on the torso, but it may sometimes affect the face, eyes or other parts of the body. Later the rash forms small blisters which eventually become cloudy and darker and crust over 7-10 days. The crusts fall off and the skin heals within 2-4 weeks.

In some situations, where the virus affects the nerves of the eyes, symptoms may include conjunctivitis, keratitis, uveitis, optic nerve palsies, which may eventually lead to chronic inflammation, loss of vision and debilitating pain. A rash on the tip of the nose is a strong predictor of eye involvement. If the virus affects the nerves of the ear, there is a risk of complications involving tinnitus, hearing loss and vertigo.

Even so, of most concern is the post-herpetic neuralgia (PHN), which is a long-lasting severe neuropathic pain that occurs in 20% of patients with shingles. This residual pain can last from months to years after the rash clears and the main risk factors is increased age. Other risk factors include severe pain, greater rash severity, increased abnormalities in the affected dermatome, presence of a prodrome and psychological factors. A study using the Short-form McGill Pain Questionnaire had patients rating the chronic pain associated with PHN to be more severe than pain associated with rheumatoid arthritis or chronic cancer (Katz and Melzack 1999). Ultimately, this may affect normal, daily activities such as walking, sleeping, social activities, as well as lead to a loss of independent living, anxiety, depression.

Can it be transmissible? 

As a matter of fact, direct contact with a shingles rash can spread the virus to a person who has no immunity. A newly infected person, however, would develop chickenpox and not shingles.

What can be done in regards to preventing Shingles?

Currently, Zostavax, is a live, attenuated shingles vaccine which is approved in Canada for use in individuals 50 year and older who have had a previous infection with chickenpox. It is the only vaccination that has been proven to help with preventing shingles. Zostavax has been shown to reduce the incidence of both shingles and post-herpetic neuralgia.

Who would be a good candidate?

Individuals who are 50 years old or above and especially those that cannot tolerate the symptoms. For example, an individual with pre-existing chronic pain or severe depression.

Is it safe for me to get the Zostavax vaccine?

There may be certain contraindications or pre-cautions to the use of Zostavax. This includes past history of anaphylaxis (i.e. to gelatine, neomycin or other components of the vaccine), immune suppression related therapies (e.g. high dose systemic corticosteroids, chemotherapy), active untreated TB, etc… For more information please speak to a pharmacist at MJ’s Natural Pharmacy.

 Do I need a prescription from my Doctor?

Currently, Zostavax is schedule II and does not require a prescription from the doctor. However, private insurance will pay for Zostavax only if there is a prescription written from a doctor.