Shingles. A Guide to Understanding Herpes Zoster. By Sarah Weis, PharmD Candidate 2012

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1 Shingles A Guide to Understanding Herpes Zoster Information Every Elder Should Know By Sarah Weis, PharmD Candidate 2012 Herpes zoster, also known as shingles, effects up to 1 million people every year in the United States. It is estimated that 1/3 of the population will have shingles during their lifetime. So what exactly is shingles? Shingles is due to a virus that most people catch during their childhood. You may hear this first infection referred to as chickenpox (varicella zoster). Chickenpox is very contagious. Most people in the U.S have come into contact with the virus but may not be able to remember the event. Most people have chickenpox as a child, although some people may get it as adults. Once the virus is in your body, it lives there forever. Later in life, the virus can become active again. It is then called shingles (herpes zoster). The older you are, the more likely it is for the virus to become active again. Varicella zoster Key Terms Also known as Chickenpox. Symptoms include: itchy red blisters, fever, headache, and you may even have a sore throat. The virus can be spread until the blisters crust over. Dormant The virus is silent. There are no signs or symptoms of the virus. The virus cannot be spread to others. Herpes Zoster Also known as shingles. The same virus becomes active and symptoms reappear in the form of a rash. The older you are, the more likely it is for the virus to become active again.

2 What are the symptoms of shingles? The main symptom of shingles is a rash. The list below may help you determine if your rash is from the herpes zoster virus. The rash is often just on one side of the body in 1 or 2 dermatomes. The rash is made of blisters, also called vesicles. They have fluid inside where the active virus lives. The rash usually lasts 7-10 days. The rash will disappear completely in 2-4 weeks. What is a dermatome? A dermatome is an area of the skin that is connected to a single nerve in your spine. When this nerve becomes irritated by the herpes zoster virus, a rash appears on the skin. The rash can be very painful and itchy. Some people experience symptoms before the rash appears. This is called a prodrome. Symptoms during this time may include strange feelings on your skin such as pain, aching, and burning. You may also have a headache, fever, or feel very tired. What should I do if I think I have shingles? Call your doctor as soon as your suspect you may have shingles. There are several medications that may help. Two medications commonly used to help with shingles are acyclovir and valacyclovir. These medications may decrease the time it takes for your rash to heal and help with pain. The medications can also decrease your chance of pain after your rash heals. 2

3 What do I need to know if I get shingles? Remember to keep your rash clean. Keep it covered if possible. Any items such as clothes, towels, and combs that come into contact with the rash should be washed in boiling water. You cannot cause the virus to become active again in people who have it. You can give the virus to others who have not been infected with the virus before. This usually occurs in young children and adults who have not had chickenpox or the varicella vaccine. If you are not sure if someone has been exposed to the virus, it is best to stay away until your rash is gone. Shingles can be very painful. Over the counter medications such as Tylenol can help. If your pain does not get better, talk to your doctor. There are other medications that can help with your pain. Sometimes, other problems can occur with shingles. These include: Infection Postherpetic neuralgia (PHN) Glaucoma and loss of vision Pain and scarring of the face Changes in skin color Talk to your doctor is you think you may be experiencing any of the above. Postherpetic Neuralgia (PHN) PHN is the most feared result of shingles. It is pain that lasts after the rash is gone. It may last from weeks to months. In severe cases, the pain may even last for years. Many people describe the pain as horrible or excruciating. The pain may be burning, aching, stabbing, or shock-like. Some people find it is even too painful to wear clothing over the area. You are more likely to develop PHN as you get older. Up to 40% of people over the age of 60 who have shingles may experience PHN. The pain of PHN can affect your daily activities and mood. You many find yourself unable to sleep or go to work. You may become depressed or withdrawn. Talk to your doctor if you find yourself struggling with PHN. There are several medications that may help. 3

4 What can I do to prevent shingles? Unfortunately, most people have come into contact with the varicella virus at some point in their life. This means most people are at risk of developing shingles. The best way to prevent shingles is to get vaccinated. Zostavax is the vaccine currently available. How safe is the shingles vaccine? Zostavax has been shown in studies to decrease shingles in those at risk by 51%. The vaccine also decreases your risk of developing postherpetic neuralgia by up to 66.5%. The vaccine became available in 2006 in those 60 years and older. As of March 2011, the vaccine is now available for those ages 50 and older. The vaccine appears to be work even better in those ages The vaccine is a one-time shot, given in the upper arm. The vaccine is made of live varicella zoster virus. The amount of virus is small enough that most people do not develop any symptoms of shingles, but the body mounts a response against the virus. This response is what protects people from developing shingles when the virus becomes active again. The vaccine has only been available since 2006, so they are unsure how long the vaccine works. The vaccine has been shown to be effective for at least 6 years. There are still several ongoing studies to see just how long the vaccine is effective. You cannot receive the vaccine if: You are allergic to neomycin or gelatin. If you have a disease that increases your risk of developing an infection such as AIDS, leukemia, or lymphoma. You are receiving medications that decrease your body s ability to fight off infection, such as high doses of steroids or antivirals. You are pregnant. You have just received the pneumococcal vaccine. You must wait 4 weeks before you can be given the shingles vaccine. 4 Risks of Vaccination The vaccine appears to be very safe. After receiving the vaccine, you may feel pain or itching where the shot was given. The area may also become red and swollen. You may develop a headache. Rarely, you may develop a rash from the virus.the rash may contain live virus. If this occurs, there is a very small chance you could give someone chickenpox who has not been exposed to the virus before.

5 Am I at increased risk of getting shingles? Because most people have been in contact with the varicella virus before, almost all adults are at risk of developing shingles. There are several factors that may increase your risk. These include: Age: The biggest risk factor. The older you are, the more likely you are to develop shingles. Your body s ability to fight off infection is decreased. Sex: Women are 11% more likely to get shingles. Race: Whites may be at increased risk. Immunosuppression due to cancer, AIDS, or stem cell transplant. Other diseases, especially inflammatory diseases such as Lupus, Rheumatoid Arthritis, and Crohn s Disease. University of Louisville Dept. Family Medicine and Geriatrics What is the cost of vaccination? The shingles vaccine may or may not be covered by your insurance. Standard Medicare does not cover the cost of vaccination. You must have Medicare Part D to be reimbursed. Private health insurance may or may not cover the vaccine for patients ages Check with your insurance provider today to see if you are eligible. If you feel you are unable to receive the vaccine due to cost, Merck may be able to help. Merck is the company who created Zostavax, the shingles vaccine. You may be eligible for Merck s Vaccine Assistance Program.