SHOULD YOU GET THE SHINGLES VACCINE?

Most of us are at risk of getting shingles because nearly all of us were exposed to chickenpox when we were kids. Helen Grange looks at this nasty disease targeting 50-year-olds and over

BONISA*, a nursing sister, had chickenpox when she was about 6. Growing up, she became accustomed to the odd fever blister, especially when she felt run down.

Then four years ago, she broke out in an angry rash on her back. “It wasn’t just a rash. Wherever the blisters were, it was painful, not just on the skin surface but deep down. It was especially painful where my clothes touched my skin,” says Bonisa.

At the time, Bonisa was under enormous stress at work. She was also looking after her elderly mother who was ill. “I’m not one to take time off work, but I had to because I felt so unwell. The pain was so severe I couldn’t bear to put clothes on. I would even try and soothe my back by facing it to the freezer. I couldn’t sleep and the pain made me irritable all the time,” she says.

A check-up a few weeks later confirmed what Bonisa suspected. She had shingles. “At first, I thought I must have scratched myself or maybe I had an allergy or an infection. Then I realised the pain went along where my nerve routes are, which was where the blisters were, and it dawned on me that it must be shingles,” she says.

Bonisa went to get a shingles vaccine, which also manages the pain.

“Once the pain was under control, my life became manageable again. All in all, my shingles nightmare lasted about four weeks,” she says.

Although the prevalence of shingles in South Africa is unknown, it has been suggested by health experts that 20 percent of people who’ve had chickenpox will develop shingles. This is because the virus that causes chickenpox, the varicella zoster, or herpes zoster virus, is the same one that causes shingles. It remains in the body, lying dormant in the root of the sensory nerves that supply the skin.

At any time, but usually when you are stressed and your immune system is compromised, the virus can reactivate and travel back down the nerve to the skin, causing the rash and the severe pain that is characteristic of shingles, explains Dr Allison Glass, a specialist virologist at Lancet Laboratories.

The first, common symptoms of shingles are tiredness and headache, followed by itching or tingling in one area of the skin. You feel pain where shingles blisters – like a rash – will soon appear.

Fever, aching muscles, fatigue and sensitivity to light are also among the early symptoms. About seven to 10 days later, a rash breaks out that looks like chickenpox, red patches that go on to form clusters of small blisters (called vesicles) filled with fluid, that break open, then crust over.

The blisters typically form a broad band that wraps around either the left or right side of your body, where the nerves connect to the skin, usually from the middle of your back towards your chest.

Sometimes the shingles rash appears around one eye or on one side of the neck or face.

Usually the skin returns to normal after two to four weeks, but like chickenpox, shingles can leave scarring and permanent changes to pigmentation. Pain can vary from mild to severe, where even a light touch or breeze on the skin can be unbearable.

“Patients describe the pain of shingles in different ways, but typically it is described as a burning sensation,” says Joburg neurologist Dr Jody Pearl.

“It was similar to the pain we felt as children playing ‘Chinese bangle’, twisting the skin around the wrist, but worse. It was like torture,” recalls Bonisa.

The pain from shingles is also difficult to treat, because according to Dr Milton Raff, a medical specialist in pain relief in Cape Town, “it is pain resulting from affected nerves that function abnormally, so regular pain medications are not effective”.

“We only have a few specialised medications we can try. If these prove to be ineffective, the pain can be incapacitating,” he says.

About one in three people who develop shingles may continue to suffer chronic pain six months after the initial rash comes and goes. “We call this postherpetic neuralgia, which can lead to sleeping problems, depression and social withdrawal,” says Pearl.

The most common medications for shingles pain is antivirals and drugs for neuropathic pain, and the cost of these in the private sector can reach about R800 a month.

Unfortunately, there is no known cure. Nor is there a way to predict who will develop the disease or what the trigger is that reactivates the varicella zoster virus, which almost everybody, at some stage of their life, has been exposed to.

What is known is the natural reduction of immunity as you age, so shingles is most common in people 50 years old and over. However, it can also be caused by illness or certain types of medical treatments, for example corticosteroids or treatments for cancer.

Shingles is less contagious than chickenpox and the risk of a person with shingles spreading the virus is low if the rash is already crusted over.

However, a person in the early rash stage should avoid physical contact with others, especially youngsters susceptible to chickenpox. Someone who has never had chickenpox can contract shingles from a person with a rash that hasn’t yet crusted over.

The good news is that a shingles-specific vaccine, Zostavax, has been available in South Africa since last year. Although it doesn’t work for everybody, it will prevent the development of shingles in up to seven out of 10 people who would’ve developed shingles if they had not been vaccinated, according to Raff.

“It also significantly reduces the occurrence or severity of pain if shingles does break out,” he says. In clinical trials, the vaccine prevented the development of shingles in two out of three people who would’ve experienced it otherwise.

“For adults over 50, the shingles vaccine is just as important. I would recommend that everyone over the age of 50 should speak to their doctor about getting vaccinated,” says Raff.

Children, meanwhile, should be vaccinated against chickenpox as part of their routine vaccination schedule, he says.

The shingles vaccine is a single-dose vaccine, available at your doctor or pharmacies throughout South Africa, for R1 254 incl Vat. *Name changed.