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).