Meet Shingles, Chickenpox’s Diabolical Cousin

by Danielle Taubman on February 26, 2013

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If you have never experienced the joys of having shingles and have never been around someone with it, you should thank your lucky stars.

Whether or not you have even heard of the virus, it’s good to be aware of what it is and to do what you can to avoid getting it.

I had actually never heard of it myself until a specific personal encounter with Mr. Shingles.  I was vacationing in Paris at the end of my trip abroad and my sister was there at the same time for a separate trip with her school.  About a day after her arrival, she began to develop a headache and to experience flulike symptoms.  She then started to feel an itchy, tingly sensation on the front area of her scalp and on her forehead.  Several days later a band of tiny painful blisters had emerged and were visible enough to attract the stares of other tourists and Parisians riding the subway with my sister.

When it got pretty bad, she asked me to take a subway across the city to her hotel room where a French doctor was scheduled to examine her.  By the time I arrived, the doctor was already assessing her condition and reaching a diagnosis.

“You have zona.”

“Excuse me?”

“It’s herpes. On your face.”

Yes, this actually happened.

Surely, my sister was upset.  But she was mostly confused.  With a fairly significant language barrier between the doctor and us and without prior knowledge of zona (the French word for shingles), we were left primarily relying on descriptions of the condition on WebMD and Wikipedia.

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For the rest of her trip my sister was in an immense amount of pain and discomfort and she had a cluster of liquid-filled bumps across her forehead.  Rather than enjoying the fresh French bread, colorful macaroons, and the stunning sites of Paris, she was forced to cope with her virus.  After days of taking an antiviral medication and resting at home upon her return, the aching side effects from her shingles ceased.  But it was a long haul until then.

My sister’s shingles was unexpected and certainly unwelcome.  It would have at least been slightly easier to deal with had she known about the virus beforehand.

So, those of you now “itching” to know what shingles really is or to get a better understanding of how it develops and how to prevent it, let’s take a look.

What is shingles?

Shingles, or herpes zoster, is caused by the varicella zoster virus (VZV).  VZV belongs to a group of viruses called herpesviruses.  Yep, herpes.  This group of viruses includes those that cause cold sores, fever blisters, and genital herpes.  Shingles is not caused by herpes simplex though, which is associated with the cold sores and genital herpes.

Being infected with VZV is what initially causes chickenpox.  Once someone has an episode of chickenpox and the chickenpox heals, a small amount of the virus lies dormant (inactive) inside nerve cells in the body near the spinal cord.  The virus can remain on the back burner for decades, just hanging out inside the body, waiting for a chance to reemerge.

Shingles happens when the chickenpox virus reactivates. VZV breaks out of the nerve cells and causes a viral skin infection in a region of the nerve. AKA shingles.

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The majority of people who have had chickenpox never end up having shingles.  The remaining unlucky sum of people usually get it beginning in their 50s or 60s (about 12.4% in a geriatric population according to one study).  Of course, my sister was 23 at the time, so it isn’t impossible to get it at a young age.  Stay tuned for the risk factors below.

If you have never had the chickenpox, you won’t get shingles. Remember, chickenpox comes before shingles! But if you have never had the chickenpox and you’re around someone with shingles (or chickenpox of course), you are at risk for getting the chickenpox (and perhaps later, shingles).

What are the symptoms?

Shingles tends to be a more powerful manifestation of chickenpox.  The first symptoms of shingles are typically headache, fever, and a general feeling of being out of sorts or unwell.  The unwelcome arrival of burning pain, itching, and pins and needles or numbness comes next.  The pain may be mild in some cases, but in other cases it’s bad enough where it becomes difficult for the person to take part in their daily activities.  The quintessential shingles rash, which is in a “beltlike” pattern, usually appears on the back or torso, but can also spring up on the face, eyes, or other locations on the body.  The rash then blisters and crusts over—sounds pleasant, right? The blisters heal within a few weeks from the body’s natural immune defense system and from prescribed antiviral medications.

For some people, their shingles results in lingering pain or complications that can last for months, or even years.  In my sister’s case, the shingles invaded one of her eyes and she has been on medication that most people take for 10 days for the last two years (!) to part ways with the shingles in her eye.

What puts you at increased risk for spending some quality time with shingles?

 The exact reason why VZV starts reproducing and flares up again is unknown, but here are some likely explanations:

Age: Being older. Shingles usually flares up in middle-aged and elderly populations.  The risk for shingles increases with age.

Disease: Immunosuppression. If someone has a weakened immune system they are more likely to have a shingles outbreak. My sister was on immunosuppressants at the time, so she falls into this category.

Cancer treatment: Going through radiation or chemotherapy.

Extended periods of stress: Stress can weaken the body’s immune system.  So, while it doesn’t cause the outbreak itself, people who recently went through a stressful life event are more likely to get shingles.

How can you prevent a meeting with this devilish virus?

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Back in my day (before the chickenpox vaccine was launched in 1995), parents with healthy children arranged unassuming “chickenpox parties” disguised as play dates with infected children.  Despite the ghastly oatmeal baths and Pepto-Bismol-colored calamine lotion required after these forced exposures, it was an act of parental love to be sure.

Because chickenpox is known to be most severe in adulthood, the idea was to expose kids at an early age and increase their immunity to getting it later.  For most people this made sense at the time.  And if parents today just don’t want their kids to get the chickenpox vaccine it may still make sense (certainly whether or not to get kids vaccinated could be an entire post).

However, the chickenpox vaccine (varicella vaccine) is highly effective and is recommended for children a year or older.  Even in cases when vaccinated kids do get chickenpox, they tend to have milder forms of chickenpox and to recover faster. Although more research is needed, kids who are immunized with the chickenpox vaccine will hopefully also be less likely to develop shingles.

More recently, in 2006, the zoster vaccine for shingles called Zostavax®s was released.  In October 2007 the vaccine was officially recommended in the U.S. for healthy adults aged 60 and over to help prevent shingles or reduce its severity. The Food and Drug Administration (FDA) recently approved it for adults aged 50 or higher.  However, the CDC has not yet added the shingles vaccine to its recommendations for adults aged 50-59. Based on a large clinical trial, the vaccine reduced the overall incidence of shingles by 51%.  Interestingly, too, if a person who had chickenpox a long time ago is around someone with chickenpox, they may reestablish their previous level of immunity for shingles with a nice new immunity boost- but it’s probably not the most effective approach for developing immunity.  Unfortunately, a general lack of awareness of shingles seems to be a significant factor in not getting the zoster vaccine (among those recommended to get it).  This suggests that increasing awareness of shingles and the vaccine can potentially impact the prevalence and impact of the virus.

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The upshot.

Nearly one million people in the United States develop shingles every year.

Although more time is needed to determine how long the shingles vaccine is effective, it is readily available and research has demonstrated its effectiveness. In fact, I keep seeing signs at Wallgreens popping up to promote the shingles vaccine. The vaccine is something everyone in the 50s and up age bracket should at least consider (though it is not recommended for everyone).

David Reedy February 26, 2013 at 2:52 pm

I was 62 at the time my brother (66) got shingles on the forehead. His doctor warned him of the risk of it getting to his eyes. Since I had been kept home from school to get infected by him, I knew I had the exact same strain of the virus he had and with a 50% genetic match I figured – get the shot. So far so good.

More of us ‘old-timers’ need to know of this shot and parents of young children need to know of the importance of getting vaccinated.

Danielle Taubman February 26, 2013 at 9:35 pm

Hi David- Thanks for your response. You bring up the idea that exposure to particular strains of VZV may increase one’s likelihood of later getting shingles. I am not sure whether this has been researched specifically, but I think in your case a precaution it was smart to get the shot (and the CDC recommends getting the shot based on age to the majority of people regardless of the presence of other potential risk factors). I do also wonder whether there is a genetic predisposition or genetic basis for the susceptibility to shingles (or to its severity once one has it). Research seems to suggest that this may be the case:

Either way, it is important to raise awareness about the shingles vaccine among elderly populations as well as among individuals who are approaching middle age.

Richard February 26, 2013 at 4:38 pm

I thought this post was very helpful. I think that lay people (like me) have a lot of confusion about the different forms of herpes virus and the fact that some forms are transmitted sexually and some non-sexually. It’s also a little confusing that there is a disease called “shingles” but it shows symptoms in completely different (specific) parts of the body in different people.

Danielle Taubman March 1, 2013 at 9:42 am

When people hear herpes, they immediately think of genital herpes or cold sores or something that pops up frequently after the initial manifestation of the virus. However, with shingles, it is very unlikely (though not impossible) to experience it more than once. It is also true that this virus can manifest itself in a number of different ways and with a myriad of symptoms, yet it is classified under one name. The connection among the different symptoms is that they all stem from VZV. The same virus that evokes very powerful and debilitating symptoms in one person may be much weaker in other individuals based on a host of different factors. I’m glad that this post at least cleared up some of this confusion for you. Thanks for reading!

Gale February 26, 2013 at 5:21 pm

I saw the lingering effects of shingles first hand when my daughter had them. It is a very persistent, nasty disease. Even though I never considered getting the shingles shot I am rethinking my position. Just reading the article and learning more about shingles gives me a better understanding of the disease and my options. And I thought I was all done with any remaining effects after I had chickenpox.

Danielle Taubman March 1, 2013 at 9:47 am

Thanks for your response. As I noted in my post, many people (even those who are most vulnerable to getting it) are unaware of shingles and unaware of its connection with chickenpox. It is certainly important that those who are recommended to get the shot are aware of its availability and its effectiveness so they can make a decision about whether it is an appropriate option for them.

Ashley Patriarca February 27, 2013 at 6:20 pm

Danielle, this is a very well-written post. Thanks! You do a great job of explaining what shingles is and how people get it.

Also, blogger Heather Armstrong (Dooce) suffered from shingles a few years ago and chronicled the experience with some hilarity, starting here: Because of her posts, I find it very hard to hear/read the word “shingles” without mentally doing jazz hands (which makes absolutely no sense until you start reading her posts, I know).

Danielle Taubman March 1, 2013 at 10:05 am

Hi Ashley! I’m so glad you enjoyed reading and learned more about shingles and its effects. Thanks for providing the blog post! Heather Armstrong certainly writes about her case of shingles with a lot of humor and emotion, which is often difficult to do with such difficult experiences. I also think it was interesting that she brought up the issue of trying to protect her newborn daughter from exposure to her shingles. In her case, her child was already born, but has a nice summary of the effects of shingles at different points of time during pregnancy on the baby:

Bryan February 28, 2013 at 9:35 am

I like how the article was interesting because you used your own personal story, I also like how you kept me aware of how to prevent it and how it is started. I had no idea what shingles were and how dangerous they are. From the name I could not tell that the infection was dangerous but now that I am aware of the infection I am going to warn my friends of how it can happen and how it can be prevented. I am still unaware of when to get the shot again if there is no determined time on how long it is effective. #SPX9

Danielle Taubman March 1, 2013 at 11:20 am

I’m glad this post informed you about shingles in an approachable way. I think spreading knowledge about shingles and sharing this information with your friends is a wonderful idea, particularly because the spread of knowledge often has a ripple effect. Again, the FDA has approved the vaccine for individuals 50 and above and the CDC currently recommends the vaccine for those 60 and older. This recommendation is based on available data and unfortunately, the vaccine has not been around long enough to know the duration of its effectiveness. With more research and time, hopefully reliable and evidence-based information on how long the vaccine is effective will be uncovered.

Maxine February 28, 2013 at 9:51 am

Dear Danielle, this blog was very informative and well written. Thank you for sharing your knowledge with me and the rest of the world. Thank you; it’s highly apperciated. Well moving on, upon reading this blog many different fact interested me; such as if a person had never had the chickenpox, the shingles could not affect them. Before, I never realized that they were so closely related. Thank you for sharing this fact to me and others. :) While reading on what you wrote on children and the chickenpox, memories of me being affected by the pox roamed my mind. I remember thinking that it was the worst feeling in the world, and now upon reading that something 10x worse could happen, it doesn’t seem so bad! Before I finish my comment I have one question to ask: Why does the chickenpox come before shingles, and why they so closely related to each other? Your feedback would be highly apperciated, thanks. :)

Danielle Taubman March 1, 2013 at 11:49 am

I’m glad you were able to learn about the relationship between chickenpox and shingles. To answer your question, chickenpox is a milder expression of the VZV virus while shingles is a more serious manifestation of the same virus. They are related because they stem from the same varicella zoster virus (VZV). Chickenpox precedes shingles simply because the first activation of VZV is in the form of chickenpox. While an individual can get chickenpox more than once, it is more common that if the VZV virus reactivates, the infection will return years later in the form of shingles. I hope this clears it up a bit more for you!

Angela March 3, 2013 at 8:13 pm

Thanks for the post! Found it super clear. Had to think back to when my friend’s mother told me that her shingles were more painful than giving birth!

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