Myths vs. Facts: Shingles

Many misconceptions exist about whether an individual can get shingles, why and at what age, and how it is treated and/or prevented. Medical providers have no doubt felt frustrated by the lack of basic understanding patients have about shingles. These common myths and facts surrounding the disease should help clear up any confusion.

Myth: I can’t get shingles because I had chickenpox as a child.

Fact: Nearly every general practitioner or geriatrician has heard the disbelief in the voice of a patient diagnosed with shingles who proclaims, “But I can’t have shingles; I had chickenpox as a child!”

Shingles is a painful rash caused by the same virus, the varicella-zoster virus (VZV), that causes chickenpox. Having chickenpox provides a patient with a lifetime immunity from another chickenpox outbreak, but it doesn’t prevent them from getting shingles. In fact, it’s little more than the first step in getting shingles, as VZV can reactivate years or decades later as herpes zoster, or shingles. So, if an individual has had chickenpox, they can get shingles at any time, without warning.

Preventing chickenpox through vaccination is one approach to minimizing the risk of developing shingles. The childhood chickenpox vaccine is now in wide use in the developed world, which may eventually make shingles far less common than is true today. But the vaccine wasn’t introduced in the United States until 1995 — meaning there are hundreds of millions of Americans who already had chickenpox as children and are at risk of developing shingles later in life. The Immunization Action Coalition reports that some 90 percent of American adults have had chickenpox, and some 30 percent of them will develop shingles at some point in life.¹

Initial studies seem to indicate that while the varicella, or chickenpox, vaccine reduces the rate of shingles eventually developing, it doesn’t seem to eliminate the incidence of shingles altogether. Because the chickenpox vaccine is a live, attenuated vaccine, some people will develop chickenpox — although generally a mild form — from the vaccine itself and thus be susceptible to developing shingles down the road.² With or without receiving the varicella vaccine, some patients may have had a case of chickenpox so mild, they never knew they had it.

So while future generations may endure a far lower incidence of shingles, for the foreseeable future, it’s a disease medical professionals are going to be treating on a regular basis.

Myth: Shingles affects only older adults.

Fact: While it isn’t known exactly what triggers an outbreak of shingles, age is likely a contributing factor. Young people can and do get shingles, but it is more common in the elderly — and more likely to be severe, meaning more painful and lasting longer than in a young person.

It is estimated that in the United States, one million cases of shingles occur every year, and an individual’s risk of getting shingles increases with age. (See the Rate of Shingles by Age Group graph.) Of those cases, almost half will occur in people 60 years of age or older. And, as the population ages, the number of cases of shingles is likely to increase.

Myth: Shingles is not a serious condition.

Fact: While generally not a serious condition, shingles can be incapacitatingly painful during its several-week run as a painful blistering rash that can appear anywhere on the body. Prior to the rash, individuals typically feel burning, itching or tingling in the area where the rash will form. A few days later, a blistering rash appears on the skin, typically on only one side of the body, and lasting up to 30 days.

For most people, the pain associated with the rash lessens as it heals. But, for some, shingles may lead to long-term pain that can last for months or even years. Because the rash inflames nerve endings themselves, traditional analgesics are often ineffective in providing relief. And even after the shingles infection has abated, a condition called postherpetic neuralgia (PHN) in the affected nerve tissue can result in lingering pain for years — pain often more difficult to treat than that of the shingles infection itself.

But while shingles typically isn’t dangerous, the incidence of serious complications from shingles itself increases with a patient’s age. Potential complications include scarring, bacterial skin infections, decrease or loss of vision or hearing, paralysis on one side of the face, muscle weakness, allodynia (pain from a source that would not normally cause pain — such as a slight breeze over the skin or the touch of clothing on the skin) and, as mentioned, PHN, which is long-term nerve pain. In addition, blindness (if the shingles outbreak covers an eye) and even encephalitis leading to death, have been attributed to shingles.

Myth: Shingles can’t be treated; it just has to be endured.

Fact: For the vast majority of human history, a case of the shingles was something patients had no option but to endure. Given that shingles is rarely life-threatening, the best advice physicians could dispense to their patients with shingles was to grit their teeth and bear it. And “bear it” is the operative phrase. But, the release of the first generation of antiviral medications in the 1980s gave medical providers their first real tool to effectively treat shingles. Historically, viral infections could be prevented through vaccination, but not treated after a patient was infected.

Coincidentally, shingles is closely related to other human herpesviridae, like herpes simplex I and II, the viruses that cause cold sores and genital herpes — the latter of which provided a potentially lucrative patient base for any effective treatments that might be introduced to market. Acyclovir was developed to fight genital herpes, but because varicella is so similar in how it replicates in a host cell, the antivirals developed to fight genital herpes (by preventing them from replicating themselves) turned out to also be effective against shingles.

Acyclovir (sold under the brand names of Acivir, Cyclovir, Herpex and Zovirax) is effective at shortening the duration of a shingles outbreak (much as it is effective at shortening a genital herpes outbreak). However, it has not been shown to eliminate the incidence of the postshingles PHN, or to significantly diminish the pain during a shingles outbreak.

Myth: There is no vaccine to prevent shingles.

Fact: While this was true before 2006, pharmaceutical manufacturer Merck was granted permission in that year to market its shingles vaccine, Zostavax, to patients 60 and older, and now real relief from a debilitating disease is at hand.

Like the varicella vaccine administered in childhood to prevent chickenpox, the Zostavax vaccine is an attenuated, live inoculation, which means patients are given a weakened strain of the virus to allow their bodies to build up their own immunity naturally with little risk of developing a full-blown case of shingles. Zostavax is administered only to those who are at least 60 years old and have had chickenpox. It is not, however, recommended for those who have a variety of medical conditions. And, patients who have never had chickenpox should still get the varicella vaccine. In the near future, Zostavax may be indicated for adults ages 50 to 59. Currently, a large, phase III study to evaluate the safety and efficacy of Zostavax in that age group is ongoing, and Merck anticipates filing for this new indication in 2010.

Zostavax has been shown to prevent shingles in half the patients given it, and to reduce the incidence of postherpetic neuralgia by two-thirds.4 Paul Richards, a public affairs specialist in the Food and Drug Administration’s Center for Biologics Evaluation and Research, says that the most common adverse reactions to the Zostavax vaccine have been “redness, pain and tenderness, swelling at the site of injection of the vaccine and headache.”

Because the risks of the Zostavax vaccine are so low, and patients’ quality of life can be so dramatically impacted by a case of shingles, the Centers for Disease Control and Prevention has recommended that all patients age 60 and older who have had chickenpox be given the Zostavax vaccine.