Cohen Medical Associates is a family medical center and research center located in Delray Beach, FL.
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What You Should Know About Shingles

When our primary care doctors in Delray Beach advise our patients over age 60 to get a shingles vaccine, it’s because the vaccine is more than 90 percent effective at preventing this extremely painful condition. The misery associated with shingles is so intense, in fact, that the Norwegian word for it is helvetesild, or “hell’s fire.”

We were reminded of how serious a case of shingles can become with the news earlier this month that California Sen. Diane Feinstein (D) had been hospitalized with a severe case of shingles. At age 89, Feinstein was especially at risk, but adults of any age can get shingles.

So here are a few things you need to know about this common affliction.

Shingles Basics

According to the Centers for Disease Control and Prevention (CDC), about one out of every three people in the U.S. will develop shingles in their lifetime.

  • If you’ve ever had chickenpox, you can get shingles. More than 99 percent of Americans born before 1980 have had chickenpox, even if they don’t remember it.
  • Even children can get shingles. However, your risk of shingles increases as you get older.
  • Shingles, also known as herpes zoster, is caused by the varicella-zoster virus, the same virus that causes chickenpox.
  • Anything that weakens the immune system can trigger the virus to reactivate.

“It never fully leaves your body. Your immune system is keeping it in check like a tug-of-war,” Toronto-based emergency physician Kashif Pirzada, told CTV News in Canada.

“If you have a big shock to your immune system like a COVID infection, or if you’re not sleeping, you’re not eating well . . . then it could flare up and cause shingles,” he explained.

A study published last summer in the journal Open Forum Infectious Diseases found that adults over age 50 who have had COVID-19 are 15 percent more likely to develop shingles within six months, CTV reports. Those who were hospitalized with the coronavirus are 21 percent more likely to develop shingles.

Signs, Symptoms, and Complications

Shingle is a contagious rash that may start as a headache with sensitivity to light, and possibly flu-like symptoms, although without a fever. It can also begin merely as painful skin.

This is followed several days or weeks later by the characteristic rash, which is accompanied by pain, burning, numbness or tingling, itching, and sensitivity to touch. The rash often turns into fluid-filled blisters. It is usually confined to a small section on one side of the torso, although it can occur around one eye or ear or on one side of the neck or face.

The rash and scabs will generally clear up within two to four weeks but may leave some scarring.

A lingering condition known as postherpetic neuralgia (PHN, or nerve pain) is the most common complication of shingles. The pain can be constant, or come and go, according to the Cleveland Clinic.

It has been described as feeling like needles piercing the skin, or it may take the form of aching, burning, itching, or stabbing. Others describe it as feeling like a migraine headache, appendicitis, or even a constant heart attack.

This period lasts at least 30 days but has been known to continue for months. For one in five people, the pain can last more than a year.

The PHN stage can prove quite debilitating, with sufferers being unable to eat, sleep, work, or carry on much of their daily activities.

The CDC reports that of the approximately 100 deaths from shingles every year, “almost all” are in older people or those with compromised immune systems.

Treatment and Prevention

It’s important that you see us if you get shingles, especially if you’re older, because the risk of complications increases with age, according to the CDC. And it is possible to pass the varicella-zoster (chickenpox) virus to someone else through direct contact with the blisters of shingles.

Shingles have no known cure, although early treatment—within three days of the onset of symptoms—with antiviral medications may speed up the healing process in some patients.

We also might prescribe various treatments for severe pain, such as numbing agents, topical patches, or other drugs.

Vaccination is the only way to prevent shingles. The CDC recommends two doses of recombinant zoster vaccine (RZV, brand name Shingrix) to prevent shingles in adults 50 years and older.

The CDC says Shingrix is more than 90 percent effective at preventing shingles and PHN. Immunity remains strong for at least the first seven years after vaccination. In adults with weakened immune systems, studies show that Shingrix is 68-91 percent effective in preventing shingles, depending on the condition that affects the immune system, the CDC reports.

One doctor who conducted a study on the effectiveness of the shingles vaccine emphasized its importance for seniors.

“The fact that we found relatively high effectiveness against serious outcomes, such as hospitalization and [lasting pain], and that protection from these outcomes were sustained over time, adds to the considerable evidence that the vaccine is beneficial and that seniors should be encouraged to be vaccinated in higher numbers than what is happening currently,” study author Dr. Hector Izurieta said in a news release.

Although the shingles vaccine is recommended for those 60 and older, a 2018 CDC study found that just 35 percent of adults in that age group had received the vaccine.

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