Do I need the shingles jab if I’ve already had shingles?

IF YOU have had shingles, can you have the shingles injection later on? I was 70 on August 9, 2012 — three weeks too old to be eligible for the shingles vaccination, which was launched on September 1, 2013, for 70 and 79-yearolds. A month ago, I contracted shingles on the base of my spine, around the hip and the groin area.

I had to take five tablets a day for seven days and am now on amitriptyline for the pain. How long is the pain and itchiness likely to last and what made them choose these ages?

Audrey Youngman, by email.

SHInGLES can affect anyone who has had chickenpox, and one in four people will develop it. From what you tell me, you were treated effectively with a seven-day course of an anti- viral drug, probably acyclovir, at a dose of 800mg five times daily.

I hope this was started promptly, as early treatment means the most significant complication of shingles, post-herpetic neuralgia, is less likely to occur.

So why does chickenpox lead to shingles? After you’ve recovered from chickenpox, the virus (varicella zoster) is imprisoned by your immune system, locked up in nerve tissue somewhere.

If your immune system is compromised in any way — for instance, because of the stress of another illness, if you’re being treated with steroids or cancer drugs, or even due to ageing — the virus can escape and travel down a nerve to reach the skin, producing the painful blistering rash of shingles, or herpes zoster.

If not treated with anti-viral therapy, the rash subsides in two to four weeks, leaving pockmark scarring and often pain, which usually ends after a month or so.

However, some patients experience continued nerve pain and intense itching, which persists after other symptoms have gone; this is known as post-herpetic neuralgia, and can sometimes last several months or longer.

BUT

as you have been treated with an anti-viral — and given pain relief in the form of amitriptyline (which works as an antidepressant at higher doses) — you should find the symptoms abate in the next few weeks (your GP has wisely anticipated the potential for postherpetic neuralgia to persist, and your treatment has been spot-on).

Zostavax, the jab now available to help prevent shingles, contains a modified form of the varicella zoster virus and is aimed at producing an immune response to that virus by making antibodies.

The single shot vaccine prevents shingles in 50 per cent of recipients, and in those who do develop the condition, the eruption is far less severe and the chance of continuing post-herpetic neuralgia only very small.

You’ve recovered from shingles because you’ve developed antibodies naturally. So there is thus no advantage in having the injection now, and it would make no difference to the post-herpetic neuralgia. Although it’s licensed for people over 50, the immunisation is rationed by the Government to save money, the cost of each injection being around £100.

The strategy chosen is bizarre and unethical, with the injections now available to people aged 70, 71, 72, 78 or 79. (Research suggests the vaccine is less effective in people over 80.)

Shingles is such an unpleasant illness and, as well as post-herpetic neuralgia, complications can include depression. I believe that the protection should be given to everyone over 50, without doubt.

But as we know, governments are not interested in ethics. CAN you offer any advice for tinnitus and hearing loss? I visited a cinema a few weeks ago when I had no hearing problems, and found the noise level almost unbearable. Since then I have suffered constant ringing, hissing or buzzing — worse in my left ear. I have read that vitamin B12 and zinc can help but I would welcome any further advice you could give me. The condition is most dispiriting.

Morgan Thompson, Newcastle Upon Tyne. TInnITUS is a ringing, hissing, buzzing or clicking sound heard in one or both ears when there is no external cause. It can be profoundly upsetting, but is not usually a sign of a serious health problem, and there are ways to minimise its impact on your life.

Occasionally, tinnitus is the result of a disorder that’s not part of the hearing system, such as problems with the jaw. Hearing loss and tinnitus can also be caused by drugs, tumours, or some abnormalities of blood vessels in the head.

Space does not permit me to describe all of these and I will limit my response to cover the event which triggered your tinnitus: exposure to excessively loud noise.

In some people, this can lead to temporary or permanent hearing loss and tinnitus. Studies suggest that damage to the tiny hair cells in the inner ear (through excessive noise, for example) results in loss of input along hearing nerve pathways.

WITHOUT

normal signals, nerve cells in the brain can spontaneously activate, causing sounds to be perceived when there aren’t any. It is a bit like phantom nerve pain.

As your noise exposure was only a few weeks ago, it is still possible that the problem may gradually resolve of its own accord.

Once the tinnitus has lasted longer than six months it’s described as chronic, and although there is no cure for most cases, there are always ways to deal with the condition.

Depression is common in tinnitus patients, and there is evidence that antidepressant medications may improve symptoms — the benefit is not so much due to antidepressant effects as the drugs’ ability to calm abnormal signals in nerve fibres.

Some patients report benefit from nutrients such as vitamin B12 and zinc, herbal remedies such as ginkgo biloba, and acupuncture and transcranial magnetic stimulation, but no studies have found these reliably effective.

The focus must be on behavioural therapies, several of which have been shown to have some success in the research.

The use of these requires a multi-disciplinary approach, with clinical psychologists, speech therapists and audiologists working as a team.

With tinnitus retraining therapy, the aim is to reduce awareness of the sound and cut out the annoyance that it causes. It may involve a mixture of counselling and sound therapy (where sounds are generated to distract the brain from the tinnitus).

Another option is cognitive behavioural therapy, which aims to change the way you think about your tinnitus.

Hopefully, your GP can refer you to an audiology consultant who has access to some of the above treatments. It is essential that you are assessed by an expert at this early stage.

WRITE TO DR SCURR

TO CONTACT Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details. Dr Scurr cannot enter into personal correspondence. His replies cannot apply to individual cases and should be taken in a general context. Always consult your own GP with any health worries.