One of the most common questions I get asked in the clinic is, “Do I really need the shingles vaccine?” The quick answer is yes, but most people appreciate more evidence to support it.
One in every three people will experience shingles in their lifetime. It most commonly affects adults over the age of 50 but can occur in children and young adults with a weakened immune system. Symptoms can start as a bizarre sensation on your skin, including itching, burning, pain or tingling. Some people also feel sick or experience headaches. One to two days after these symptoms, painful blisters appear in a band on one side of the body. This is when treatment is most effective.
Treatment may include an antiviral medication, such as acyclovir or valacyclovir, along with medication to help with the pain. This includes ibuprofen or naproxen, but sometimes steroids and medications for nerve pain are required.
Symptoms may not only be limited to a painful rash, though. Ten to 18% of people who have shingles develop long-term nerve pain at the site of the rash. This is known as postherpetic neuralgia and is one of the most common complications of shingles. Medications, both oral and topical, are needed to manage this condition, yet are sometimes unhelpful in relieving the pain. Complications can also include vision loss, hearing problems, infection of the brain and even pneumonia.
So, how does someone get shingles? Chickenpox and shingles are diseases that occur from the same virus: varicella-zoster virus. When the virus first infects a person (usually as a child), it causes chickenpox, an itchy, blister-like rash that covers the entire body. The body then fights off the virus and the rash resolves. The virus isn’t completely gone, though. It hides in the nerves near the spinal cord and as we age, our immune system decreases. This creates the perfect conditions for the virus to awaken, resulting in shingles.
Another question I get is, “Is shingles contagious?” The answer is yes, although it doesn’t result in the spread of shingles but of chickenpox. A person is considered contagious from the time blisters appear until the rash scabs over. Those who have not been vaccinated for chickenpox, have never had chickenpox or have a weakened immune system are at increased risk of developing chickenpox when exposed. Hand washing and covering the rash also prevents the spread of the virus. The best prevention of shingles and its complications, though, is vaccination.
Vaccination is recommended for people over the age of 50 as well as for those 19 years of age and older with a weakened immune system. Some individuals may remember a single vaccination (Zostavax) that used to be recommended; however, a more effective vaccine has been developed called Shingrix. This vaccine is a two-shot series, with the second round given two to six months after the original vaccination. It is recommended you get the vaccine even if you have had shingles, as it decreases the likelihood and severity of it happening again.
People who previously received Zostavax should also be vaccinated with Shingrix. As with many other vaccinations, side effects can include pain, redness and swelling where the injection is given. Flu-like symptoms, including fatigue, muscle aches, headache, chills, fever, stomach ache or nausea, may also occur. Symptoms resolve by two to three days if they occur at all. A rare complication includes Guillain-Barré Syndrome.
With a prevention rate of 90%, I recommend Shingrix to all my patients who qualify, as it is safe, effective and reduces the risk of complications that may be difficult to manage.
Dr. Brittany Pendergraft is a resident physician in the Bothwell-University of Missouri Family Medicine Residency program, working alongside mentoring physicians within the Bothwell health system. Pendergraft received her undergraduate degree in Biology from the University of Arkansas in Fayetteville, Arkansas. She then earned a master’s degree in Biomedical Science from Kansas City University of Medicine and Bioscience and completed her medical degree at the University of Missouri-Columbia School of Medicine. Pendergraft is accepting patients of all ages at Bothwell Family Medicine Associates. To make an appointment to see her, call Bothwell Family Medicine Associates at 660-827-2883.
