Seniors Should Get Shingles Vaccine

Published by Contra Costa Times

Posted on Tues., October 14, 2008
By Stephen Daniels, MD

MARY THOUGHT she must have pneumonia or be having a heart attack because her left chest hurt so much.

"I just can´t stand the burning feeling, Dr. Daniels, or I wouldn´t have come in."

She lived alone, so hadn´t noticed the red bumps and blisters on the back of her chest.

John thought he must have bumped his forehead, or scratched himself during the night. The right side of his forehead was painful and had red bumps and a few blisters.

"I got scared when my right eye got blurry and felt like I´d scratched it."

Both these elderly patients had shingles (also called herpes zoster), which is a recurrence of childhood chickenpox.

As chickenpox gradually resolves in children, the chickenpox virus, called varicella, actually retreats to the spine, where it hides, often for decades.

Then, usually when the person is elderly or suffers lowered immunity, the virus leaves the spinal chord and follows a single nerve out to the skin, sometimes causing severe pain and burning, as well as redness and blisters.

Shingles can occur anywhere on the body, from the buttocks to the abdomen to the chest, all the way to the top of the head. A unique feature of shingles, which often helps in the diagnosis, is that it almost always affects only one side of the body.

Sometimes, though, shingles begins with just pain in the face, chest, abdomen or buttocks, and the rash doesn´t start for a few days.

And, a shingles sufferer may not see the rash if it occurs on the back or buttocks, especially if he or she lives alone and doesn´t think to look in the mirror. This can make treatment difficult, since it is most effective if started within three days of the onset of pain.

A shingles infection of the eye is particularly worrisome, since it can cause scarring of the cornea—the clear covering of the eyeball—and impair vision. If this occurs, a corneal transplant may be necessary to restore normal vision.

Medical therapy usually consists of an anti-inflammatory drug such as prednisone, an antiviral medicine such as acyclovir and a medicine for the pain.

If untreated, shingles rash and pain may last a month or more. Treatment can shorten the length of the rash, and reduce the likelihood of persistent pain.

Persistent pain, called "post-herpetic neuralgia," which sometimes lasts for many years after the rash is gone, affects 40 percent of shingles sufferers who are over the age of 60.

Since May 2006, there has been a vaccine available for seniors to prevent or reduce the severity of shingles should it occur. Since seniors over 60 are the group most likely to get shingles, they should ask their doctor about getting the shingles vaccine.

The vaccine appears to be most effective when given between the ages of 60-69. So don´t wait.

Even people who don´t recall having had chickenpox as a child, and those who have had shingles, should get the vaccine. Studies suggest that 99 percent of adults in the United States have had chickenpox, and are at risk of getting shingles.

We hope that shingles will become a disease of the past, since all children now have the opportunity to be vaccinated against chickenpox.

Daniels practices family medicine at the Concord and Pittsburg Health Centers, parts of Contra Costa Health Services, the county health department.