Apr 29

Shingles: Vaccination

by Sara Heineman

Shingles – as my dad jokes, “you aren’t talking about the things on your roof.” He had what he refers to as “minor” case of the shingles a few years ago. Anyone who has ever had shingles – Herpes zoster – can attest, it is not a pleasant experience.

Shingles is a little tricky. It is a virus that’s caused by the chickenpox virus – Varicella zoster – that you may have had as a child. Even though the blisters disappear, the virus that caused chickenpox actually lays dormant in your nerve roots. As we age, our immune system naturally starts to weaken. This natural “immunosuppression” can be compounded by chronic medical conditions or medications. These stressors on our immune system allow the sleeping dragon Varicella to wake angrily as shingles.

Most people experience some kind of localized pain or burning sensation before a rash appears, sometimes accompanied by general malaise or headache. Typically, the rash follows one or two nerve pathways, or dermatomes, on one side of the body. The most common location is the chest or thoracic area, so imagine a rash starting on the right side of your back, beneath your shoulder blade and wrapping around the right side of your body to the right side of your chest.

The rash can last two to four weeks, starting with clusters of clear blisters, or vesicles, that gradually crust over. Because the nerves are inflamed, this can cause severe pain and discomfort. Sometimes this nerve pain continues for weeks or months after the rash has resolved. This residual pain is one of the most common complications of shingles and iscalled post-herpetic neuralgia.

According to the Centers for Disease Control and Prevention there are approximately 1 million cases of shingles each year in the United States. Most of these cases occur in people older than age 60. While shingles typically only occurs once in a lifetime, there are those unlucky enough to experience it two or even three times in their life.

Besides the general discomfort of the rash, other potential complications of shingles include bacterial infection from itching/scratching the lesions, nerve palsies and post-herpetic neuralgia. Depending on the nerves involved, serious complications can cause blindness or meningoencephalitits – swelling of the brain and meninges.

The shingles virus is not only an “angry dragon” but it can be very devious, too. You cannot give someone shingles while you have shingles, however you can give someone chickenpox. That said, if you have shingles, you are contagious with the chickenpox virus and you should avoid contact with anyone who is not immune to chickenpox either from having had the disease or from being vaccinated.

Successful treatment of shingles requires quick recognition of the symptoms in order to start antiviral medications and manage the pain, itching and general discomfort. Although you can’t prevent it 100 percent of the time, there is a vaccine, Zostavax, that can reduce your risk of developing shingles.

According to the CDC, for people ages 60 to 69, the vaccine can reduce the risk of developing shingles by 51 percent and the risk of post-herpetic neuralgia by 67 percent. The most recent research from the CDC indicates that the vaccine is effective for at least six years and maybe longer. Ongoing research continues to look at vaccine effectiveness and this research will help guide future recommendations.

Currently, the CDC recommends anyone older than 60 get vaccinated for shingles, even if they have already had the disease. The Federal Drug Administration recently approved Zostavax for people age 50 and older. It is advisable that you and your medical provider discuss when the best time is for you to get vaccinated. There are no recommendations for booster doses at this time. Zostavax does not prevent other types of herpes viruses, such as genital herpes, and should not be used during an active shingles infection.

When talking with your medical provider about when you should get the shingles vaccine, you should also talk about potential contraindications or precautions for receiving the vaccine. You should not get the vaccine if you are:

• Allergic to gelatin or neomycin.

• Severely immunosuppressed because certain medical conditions, medications, or treatments (such as HIV/ AIDS, cancers or cancer treatment, taking steroids or other immunosuppressive medications).

• Pregnant.

The most common side effects associated with the vaccine include redness, swelling or soreness at the injection site. According to the CDC, there is no documented history of a person getting chickenpox from someone because they received the shingles vaccine, thus it is considered safe for a newly vaccinated people to be around infants, pregnant women and people with weakened immune systems.

The cost of the shingles vaccine can be perceived as quite expensive – $200 or more – and thus a barrier to getting vaccinated. However, when you compare the cost of the vaccine to the expense of medical treatment for the disease and consider how the illness could impact your daily activities, it might just be worth it.

Eventually with the Affordable Care Act, all insurance companies will pay for preventive services that include vaccines such as shingles. Currently, there are some insurance companies that are “grandfathered” until they make benefit updates and therefore do not cover vaccines yet. Medicare Part B covers the flu and pneumonia vaccines while Medicare Part D includes the shingles vaccine. It is best that you contact your insurance company and find out if it covers the shingles vaccine for you at your current age.

If you don’t have health insurance and can’t afford the vaccine, there is a patient assistance program available through the vaccine manufacturer.

Knowing as much as possible about shingles can help if you or a senior under your care develops the condition. Getting treatment early may help lessen the severity, prevent complications and shorten the duration of the disease. If you suspect that you or someone in your family has shingles, seek medical care quickly. And, if you haven’t already, talk with your medical provider about getting vaccinated.

Sara Heineman is the Missoula City-County Health Department outpatient clinic nursing supervisor and can be reached at 258-4987 or at sheineman@co.missoula.mt.us.

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