Following on from my last blog post on the chickenpox vaccine, it seems appropriate to complete the loop with a discussion around the shingles vaccine.
Shingles is a very common and troublesome infection that is seen more frequently with age. Data from England and Wales suggests that over 50,000 cases of shingles occur in people over the age of 70 annually, with around 20% of the population likely to suffer with shingles at some point in their lifetime.
Shingles only occurs in those that have had chickenpox in the past and the reason for this is that when we have chickenpox in childhood, the virus travels along our sensory nerves and settles in the spine where it in effect will lay asleep until awakened.
This wakening from a dormant state typically occurs when we go through times of immune suppression, for example, immunotherapy, HIV infection or cancer. But it also happens as we age due to our immunity not being as strong.
How shingles presents
Typically shingles begins with abnormal skin sensations and pain in the affected area of skin (called a dermatome). Some people will also get a headache, feel generally unwell, find light bothers their eyes and in some occasions have a fever.
Normally within a couple of days or weeks the characteristic shingles rash will appear. It is usually in one dermatome (for example a very clear line across the abdomen or back) but can include more than one dermatome.
The rash has multiple fluid filled blisters (vesicles) and the affected area can be intensely painful and itchy. The rash normally lasts around 2 to 4 weeks.
Post Herpetic Neuralgia
Unfortunately for some people, the shingles rash leaves the skin to be incredibly painful and sensitive, even once the rash has gone. This is termed post herpetic neuralgia and the pain can be brought on by light touch of the skin or even the wind blowing against it. It is very difficult to control the pain with medication.
The other complications that people can have from shingles include facial palsy, paresis (motor weakness) and if shingles affects the dermatome around the eye (called herpes zoster opthalmicus) it can cause a lot of problems with the eye itself.
Besides the above, the reactivated virus can sometimes cause pneumonia, hepatitis, encephalitis and disseminated intravascular coagulopathy.
The role of Zostavax
Having discussed all the complications of shingles, it isn’t difficult to see why the vaccine (called Zostavax) is now recommended.
The NHS currently offers the shingles vaccine to people in their 70s. This is because as mentioned earlier shingles is more common in those over 70 (around 800 to 1000 per 100,000 people per year), however, a large number of adults get shingles in their 60s too (between 700 and 800 per 100,000 per year).
The vaccine is safe for most people and reduces the risk of developing shingles by 51% in those aged 60. It also reduces the risk of post herpetic neuralgia by 66.5%.
The full duration of protection by Zostavax is not known. The latest data suggests it lasts at least 5 years but as yet we do not know how much longer the protection lasts beyond that and also whether it is worth having a shingles booster later on. This is all currently being looked into.
If you are interested in finding out more about the shingles vaccine or would like to discuss having it done privately before you qualify for it on the NHS immunisation programme at the age of 70, contact us at ROC clinic.
