Approximately 25% of people develop shingles during their lifetime, with the majority of cases occurring in those over 50 years of age.

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1 ÜNZÜLE ALPASLAN

2 WHAT IS SHINGLES? Shingles is an infection of an individual nerve and the skin surface that is supplied by the nerve; it is caused by the varicella-zoster virus - the same virus that causes chickenpox.

3 Approximately 25% of people develop shingles during their lifetime, with the majority of cases occurring in those over 50 years of age. In the United States, there are approximately 1 million cases of shingles per year.

4 Causes of shingles In most shingles cases, there is no known reason why the varicella-zoster virus begins multiplying. One suggestion is that shingles occurs when something weakens the immune system, prompting the virus to reactivate.

5 Some possible triggers for shingles include: Aging Diseases - including certain cancers and HIV/AIDS Cancer treatments - chemotherapy and radiation therapy lower resistance to disease Stress or trauma - psychological and emotional stressors

6 Medications - immunosuppressive drugs; after a transplant, a high percentage of patients develop shingles Children - youngsters whose mothers had chickenpox late in pregnancy or had chickenpox in infancy themselves

7 Symptoms of shingles The most common symptom of shingles is pain - a constant dull, burning, or gnawing pain, or sharp, stabbing pains that come and go. Other common symptoms include tender skin and a blistering rash.

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9 Typically, shingles takes the following course: Acute pain, tingling, numbness, and itching on a specific part of the skin, on a single side of the body. 1-5 days after the pain begins, a rash appears. Red blotches emerge that develop into itchy fluidfilled blisters. The rash looks like chickenpox but only on the band of skin supplied by the affected nerve.

10 The rash may involve the face, eyes, mouth, and ears in some cases. Sometimes the blisters merge, forming a solid red band that looks like a severe burn. In rare cases (among people with weakened immune systems) the rash may be more extensive and look similar to a chickenpox rash.

11 Shingles can affect the eye, called optical shingles. The virus invades an ophthalmic nerve and causes painful eye inflammation and temporary or permanent loss of vision. New blisters may arise for up to a week. Inflammation might be caused in the soft tissue under and around the rash.

12 People with lesions on the torso may feel spasms of pain at the gentlest touch. The blisters will gradually dry up and form scabs or crusts, in 7-10 days. At this point, the rash is no longer considered infectious. Minor scarring may occur where the blisters have been. A shingles episode normally lasts 3-5 weeks.

13 In some cases, there is a rash but no pain; or, no visible rash but a band of pain. Other symptoms of shingles can include: Fever Headache Malaise Nausea Muscle pain and weakness Chills Upset stomach Difficulties with urination Fatigue Joint pain Swollen glands (lymph nodes) Rarely, shingles can lead to pneumonia, brain inflammation (encephalitis), or death. This usually happens in people who have an impaired immune system.

14 If the rash effects areas of the face, symptoms may include: Difficulty moving some facial muscles Drooping eyelids (ptosis) Hearing loss Loss of eye motion Problems with taste Vision problems

15 Most people do not experience any complications with shingles, but there is the potential for the following longlasting effects: Postherpetic neuralgia (PHN) - occurs in percent of shingles patients Peripheral motor neuropathy - occurs in 5-10 percent of cases Skin infection Encephalitis (inflammation of the brain) Transverse myelitis (inflammation of the spinal cord) White patches due to loss of pigment in the rash area Eye problems Weakness

16 Diagnosis of shingles Shingles can be diagnosed by a doctor based upon the distinctive appearance and distribution of the rash along a dermatome. In cases where diagnosis is unclear, shingles can be confirmed by testing a swab of fluid from the blisters or blood for antibodies to the varicella-zoster virus.

17 Treatment of shingles There is currently no way to eliminate the shingles virus from the body, but several measures can be taken to ease symptoms: Keep the rash dry and clean to reduce risk of infection. Loose-fitting clothing will feel more comfortable. Rub-on antibiotic creams or adhesive dressings are not advised as they can slow the healing process. If the rash needs to be covered, a non-adherent dressing should be used to prevent aggravating the skin.

18 Calamine lotion can soothe and relieve the itching. Antihistamines can sometimes be useful to prevent itching at night. In some cases, antiviral medicine may be prescribed to help stop the virus multiplying, and to reduce severity and duration.

19 Prevention Before the blisters develop and after the crusts form, the person is not contagious. Shingles cannot be passed from one individual to another. However, the varicella-zoster virus can be spread from a person with shingles at the active stage to someone who has never suffered from chickenpox. In these cases, the infected individual would get chickenpox, not shingles.

20 Shingles is not spread through coughing or sneezing but through direct contact with fluid from the blisters. Before the blisters develop and after the crusts form, the person is not contagious. Shingles is less contagious than chickenpox. The risk of spreading the virus is low if the rash is covered.

21 Bone marrow unit: If the zone is widespread and active, respiratory and contact isolation is taken. If the zone is not active and not widespread, only contact isolation is taken. The patient is taken to the negative pressure room.

22 Transmission-based Precautions CONTACT PRECAUTIONS DROPLET PRECAUTIONS AIRBORNE PRECAUTIONS

23 Vaccines Chickenpox vaccine Immunization with the varicella vaccine (chickenpox vaccine) is now recommended and routine in America. It is a two-dose vaccine, given once between 12 and 15 months and again between 4 and 6 years old. Shingles vaccinethe Zostavax vaccine for varicellazoster is approved for people over 50 who have had chickenpox. As a result, the number of shingles cases has dropped by 50 percent.

24 Some people should not get the shingles vaccine, or should discuss it with their physician; including: Anyone who has ever had a severe allergic reaction to gelatin, the antibiotic neomycin, or any other component of shingles vaccine Anyone with a weakened immune system Women who are or might be pregnant

25 Prognosis Shingles typically resolves within 2-4 weeks and the prognosis is excellent for young healthy individuals who develop shingles. Approximately 1-4 percent of people who develop shingles require hospitalization for complications and 30 percent of those have impaired immune systems.

26 It is estimated that there are about 96 deaths per year directly related to the varicella-zoster virus, the majority of which occur in older adults and those who are immunocompromised.

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