HERPES ZOSTER-SHINGLES. NOT A GOOD THING TO HAVE
November 1, 2009 by Carol Duff · 16 Comments
HERPES ZOSTER(SHINGLES)- YOU HAVE A CHANCE TO AVOID IT!
By Carol Ware Duff MSN, BA, RN
Shingles is an malady that can cause blisters which can produce intense pain and affect the way you deal with the usual activities of daily living. There is an adult vaccination that can give you protection against Herpes Zoster.
Shingles is a neurocutaneous (nerve/skin) disease whose full name is varicella zoster virus (VZV). Shingles is simply a viral infection of the nerve roots. With this viral infection there is usually pain and a rash on one side of the body. The rash follows along the path of the nerve, therefore it will usually be in the shape of a strip or band. If someone else in your family has had shingles, you are four times more likely to also get it. About one million people in the United States suffer from shingles every year and one half of these will be over 60. More than half of the people who reach 85 will develop shingles.
Having chickenpox earlier in life is a reason for a later-in-life visit from shingles. The chickenpox (varicella) virus usually stays dormant after the initial case of chickenpox but sometimes the virus reawakens after remaining inactive for most of your life. People who have weakened immune systems, have been injured, are stressed, or take certain medicines may suffer with shingles. The process of aging can be the stressor to reactivate the varicella virus. Having cancer or being treated for cancer can produce a case of shingles. For most people shingles is a one time illness and will develop after the age of 50.
Shingles is not contagious but someone with the shingles rash can spread chickenpox to anyone who has never had chickenpox or has not been vaccinated against varicella. The fluid from the blister of shingles can cause a person who has never had chickenpox to get it. If you have shingles you should stay away from anyone who has an immune system disorder, pregnant women, and of course babies before they are vaccinated against varicella. After the rash heals you will not be able to infect anyone. Remember you cannot give another person shingles, but do stay away from anyone who is currently ill. Covering the blisters with a bandage that will absord the liquid that seeps from the rash/blisters will help to stop the spread of the virus.
The symptoms for shingles usually come in stages which may begin with a headache or sensitivity to light, feeling like you have the flu without the fever, itching, tingling and pain of the skin with a rash developing a very few days later. The rash becomes blisters filled with fluid and will eventually crust over. These blisters will take two to four weeks to heal and may ultimately leave scars or skin discoloration. The rash can range from severe, to mild, to cases with no rash appearing at all. If you have shingles for a long time, or have the rash on your face you can experience changes in how you function mentally, changes in your sight, feeling of dizziness and weakness. If any of these problems occur you should call your healthcare provider immediately. Pain is felt by almost everyone who has shingles and for some, this pain may be the worst they have ever experienced.
Herpes Zoster has no cure, but you can receive treatment to help you feel better sooner and to prevent other problems. The earlier you begin treatment, the quicker treatment will work and you can feel better.
Treatment for shingles may include antiviral medications to decrease the viral activity that causes the pain and will decrease the recovery time. Antivirals which can be taken orally or given intravenously (though the vein) keep the shingles virus from multiplying, can decrease the period of rash formation, decrease pain during the active stage of the illness, and reduce the possibility of complications. Antivirals work especially well in those over 50, those who are immune compromised, and those who have the rash on the face, near an eye, and/or on the forehead.
There are medications to treat long-term pain caused by shingles. These medications may include skin creams, pain medicines, or antidepressants. It is important that you take your medicine as directed and keep you skin clean. Topical antibiotics may be used to prevent skin infection and over the counter pain medications such as aspirin, ibuprophen, and acetaminophen can help to reduce the pain. Corticosteroids such as prednisone can be given for those under 50. Those who have severe, unrelenting pain may need nerve blocking injections and or require opiods such as morphine, codeine, or oxycodone.
Medications may reduce your chances of developing complications from shingles. One of the major complications of shingles is postherpetic neuralgia also called disseminated zoster. Postherpetic neuralgia is associated with pain, and or headache that occurs as a complication of having shingles. This severe complication can last for an extended period of time from 30 days to months and years. People who develop shingles after age 50 and who have severe rash and pain during their episode of shingles are those with the greatest risk for developing this complication. Postherpetic neuralgia is associated with intense pain that may make it difficult to sleep, eat, and to perform the activities of daily living. Because it causes such pain and is distressful, there is an increase in the risk of developing depression. This complication is hard to treat, therefore early treatment with antivirals is necessary. Postherpetic neuralgia can last up to a year and medications that can be given to alleviate symptoms are antidepressants, opioids, and anticonvulsants. Early treatment may prevent this complication and it is important to seek early treatment because as many as 40% to 50% of people who develop postherpectic neuralgia do not respond to treatments. Approximately 90% of those who develop postherpetic neualgia will have allodynia or pain from something that would not normally cause pain, such as a breeze on the skin. This feeling can be quite disconcerting.
Another complication from herpes zoster is disseminated zoster which is a blistery rash that spreads over a large portion of the body and can affect the heart, liver, lungs, pancreas, joints, and intestinal tract. There may be temporary weakness as the nerves that control movement are affected. Shingles can affect the nerves that arise from the brain (cranial nerves) and cause pain, inflammation, loss of feeling in one or both eyes, may threaten vision, rash may appear on the side and tip of the nose (Hutchinson’s sign), intense ear pain, rash around the ear, mouth, on face, neck and scalp and loss of movements of the facial nerves (Ramsay Hunt syndrome). There can be loss of hearing, dizziness, loss of taste, dry mouth, ringing in the ears, and dry eyes. Inflammation and possible blockage of blood vessels can lead to a stroke. There is always that chance of a bacterial infection of the open skin/ blisters. Herpes zoster opthalmicus is a rash on the cheek, nose, forehead, and around one eye. Prompt attention from an ophthalmologist (eye doctor) is needed for this type of shingles. Meningitis can also be a serious complication from having shingles.
Since anyone who has gotten the childhood disease varicella can later get shingles, it is wise to get vaccinated to prevent this painful and annoying occurence. The Centers for Disease Controland Prevention (CDC) recommends the vaccine for those over 60 who have never had shingles. The vaccine (Zostavax) for the prevention of shingles has been recommended for those over 60 since the spring of 2006. This is recommended for those over 60 whether or not that they have had shingles before. If you have never had chickenpox you should get the chickenpox vaccination which will mean that you will not get shingles. If you have not had chickenpox or the chickenpox vaccine, avoid being near anyone who has shingles until after their rash and blisters have healed. Remember that fluid from a shingles blister can cause a case of chickenpox, but not a case of shingles.
The herpes zoster vaccine gives immunity to shingles within 30 days and the length of the protection is not definitively known because the vaccine has not be in use for an excess of years. It is hoped that there will be life-time immunity. This vaccine should not be given to those who have allergies to gelatin, neomycin (either topical or systemtic), to those with primary or acquired immune deficiencies such as lymphomas, leukemia, malignant bone marrow, or lymphatic system neoplasms, and human immunodeficiency virus. Those who have had high-dose corticosteroids (20 mg/day or 2 mg/kilogram/day of prednisone or an equal dose of other systemic corticosteroids should not receive the vaccine because steroids will decrease the immunity level that the vaccine would provide. People who are being treated for active tuberculosis, women who are pregnant,and those who have an acute illness should not be vaccinated.
Some of the new drugs to treat rheumatoid arthritis, ankylosing spondylitis, psoratic arthritis, and Crohn’s disease can cause reoccurences of shingles. These drugs are called TNF (tumor necrosis factor) alpha blockers and work by removing the out of control immune responses that cause these diseases. Some of these drugs are Kineret, Humira, and Remicade and it is found that they can reactivate the shingles virus. With the increase chance of reactivation of the herpes zoster virus, there does not seem to be the increased chance of severe shingles with postherpectic neuralgia. Usually taking the herpes zoster vaccine several weeks before starting the treatments with anti-TNF drugs is recommended. The vaccine is a live virus and cannot be give during treatments with anti-TNF drugs.
As with other live viral vaccines, people who have received immunosuppressive therapies, corticosteroids, or radiation could possibly receive a less effective immunization response, which will leave these people more susceptible to shingles even if they have received the vaccination. Steroids should not be used for 2 to 3 weeks after the live herpes zoster vaccine has been given. Those who have received the chickenpox vaccine should not receive the herpes zoster vaccine. Very few adults over the age of 60 have received the chickenpox vaccine.
If you are on medications to treat other herpes infections, such as famciclovir, valclyclovir, and acyclovir, these can prevent adequate replication of the live attenuated vaccine virus. No anti-herpetic medications should be given within 24 hours of giving the herpes zoster vaccine and after the vaccine is given, withheld for at least 2 weeks post vaccination.
Local reactions at the injection point of swelling, pain, itching have been reported during the first 42 days after vaccination. There have also been reports of headache.
The Shingles Prevention Study used more than 38,000 men and women, 60 or older at 22 sites across America. Sixteen VA medical centers and six other clinical sites were coordinated by the National Institute of Allergy and Infectious Diseases (NIAID). Half of the people received the zoster vaccine which was a live attenuated (weakened) form of the varicella-zoster virus which is responsible for chickenpox and shingles and one half received a placebo. This vaccine has been developed for and studied in older adults and is a stronger version of the vaccine that is designed to prevent chickenpox in children (1995).
There is an effective anti-shingles vaccine that can be given to most of the public over the age of 60. The chances of getting shingles is high and the complications from the disease can be debilitating. Vaccination with Zostavax makes medical sense. Vaccination against shingles is one of the immunizations recommended for adults.
References
Boyles, S. (2008). CDC: Adult vaccination rates too low. Retrieved on October 31, 2009 from http://www.medscape.com/viewarticle/569179
Centers for Disease Control, 2008. Prevention of Herpes Zoster. Retrieved on October 31, 2009 from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e0515a1.htm
Kockler, D., & McCarthy, M., 2007. Herpes vaccine live. Retrieved on October 31, 2009 from http://www.medscape.com/viewarticle/559568
Lehman, Laura (2008). Should a person exposed to shingles receive the Zoster vaccine? Retrieved on October 31, 2009 from http://www.medscape.com/viewarticle/583416
United States Department of Veterans Affairs (2007). Shingles vaccine proves effective in large VA trial. Retrieved on October 31, 2009 from http://www.csp.research.va.gov/news.cfm?id=3
WebMd, 2009. Rheumatoid Arthritis Center. Retrieved on October 30, 2009 from http://www.webmd.com/rheumatoid-arthritis/news/20090217/arthritis-treatment-ups-shingles-risk
WebMd, 2009. Shingles (herpes zoster). Retrieved on October 30, 2009 from http://www.webmd.com/skin-problems-and-treatments/shingles/shingles-topic-overview
Carol Duff graduated from Nursing School at Riverside White Cross in Columbus, Ohio.
She has a BA from Bowling Green University in History and Literature and a Masters of Science in Nursing as a Nurse Educator from the University of Toledo School of Nursing.
She has traveled extensively and has written on military history, veterans health issues and related subjects. She is the mother of several children and 11 cats and 1 guinea pig.
She can be reached via email at: Thehertz@aol.com
Carol,
You said ” People who have weakened immune systems, have been injured, are stressed, or take certain medicines may suffer with shingles. The process of aging can be the stressor to reactivate the varicella virus.”
Almost everyone has been exposed to the virus at one time or another in life, and now carries the anti-bodies. This exposure usually occurs in infancy or early childhood and causes the blisters. If the individual’s immune system is healthy, these blisters heal and do not return as the neural pathway is blocked by the immune system. If the immune system is ever compromised, the virus can break out and replicate again with the blisters. I had my first herpes outbreak as an adult shortly are being “treated” with psychiatric drugs, which weaken the immune system. For the eight years that I took those drugs, I had many breakouts. When I began an orthomolecular program and was able to withdraw from the psych drugs and renew my immune system, the breakouts almost stopped entirely. I say “almost” because even if I went several years without a recurrence, an extremely emotional or physical situation could still trigger a small breakout. Then I learned of a treatment that has kept the little bastards heads down like Ma Deuce for many years. Stannous Fluoride is an anti-viral agent which works by killing the nerves in the skin or mucous membrane which are the final gateway to herpes breakout. This chemical compound (non-patentable) is used in dentistry to prevent and treat viral infections, including herpes in the mouth, and works very well. Dentists would not be happy working in a mouth having herpes outbreaks without having stannous fluoride available. Vets will probably remember the boot camp gargle with strong fluoride. This took care of any infections in the mouths of recruits who had never seen a dentist or brushed their teeth! Unfortunately, stannous fluoride is not approved by the FDA for use anywhere else on the body where the sales of other patented, prescription drugs might be affected, even though those drugs are nowhere near as effective on herpes as stannous fluoride and can have harmful side effects. Well, kids are smart and when the epidemic of herpes began in the 1970s, primarily due to poor nutrition and its damaging effects on immune systems, kids eventually discovered that TOOTHPASTE, applied to a “cold sore” and allowed to dry would dry up the blister in a day or two, and that it never returned in the same place (because the neural network had been shut down by the stannous fluoride). There is a much more potent source of stannous fluoride in a Colgate product called Gel-Kam available in some states without a prescription but not in others. Google “Gel-Kam and herpes”. Lots of people know about this. Gel-Kam does cause “nerve damage” and that is the reason why is is not approved for use outside the mouth (the dental profession). However, stannous fluoride, in the form of a tiny dab of Gel-Kam, only has to be used once at the site of each blister, so nerve damage in minimal. Many people can tell when they are about to have a breakout and see the spot of red skin and feel the tenderness than precedes the blister. Gel-Kam applied at that point will frequently prevent the formation of the blister. Neck pain can also be an indicator that a breakout is imminent. So, a good strategy many have found to deal with herpes is to build up the immune system with a healthy life style, good nutrition and supplementation, and finish off any hard core “dead enders” with a dab of Gel-Kam. If we follow medical logic to its Aristotelian conclusion, we find that first, almost everyone has been exposed to herpes and is potentially contagious. Second, there is no way to determine if one is contagious or not because blisters are not required to transmit the virus. Therefore, nobody should ever kiss anyone else, ever. I could not live like this. The next step would be a bubble suit for everyone!
Subvet416,
This particular article just deals with the herpes zoster (shingles) not the other herpetic viruses. Herpes Simplex Type 1 is usually the culprit for sores in and around the mouth. There may be tingling and pain days before an outbreak of Herpes simplex, due to nerves being manipulated by the virus. Herpes simplex often is reoccuring while shingles or herpes zoster is usually a one time occurence. If a person has shingles and the blisters that usually accompany it, the only way someone can be exposed is through the actual transfer of the fluid from the blisters. Even then herpes zoster will cause chickenpox (varicella) in those who have not already had the disease or the vaccination for it. I believe that I remember toothpaste ads, when it was first put on the market with flouride added, as using the marketing words of stannous fluoride. A more accurate term for it is tin(II) fluoride. Gel-kam that you mention and Flo-gel are used to apply fluoride to the teeth, often in a dentist’s office. When you receive the warning "no eating or drinking for 30 minutes" you have had a fluoride treatment which is supposed to strenthen the enamel on teeth.
Weakened immune systems, and stress alone can make our immune systems less effective, can allow these viruses to make a home in us. Healthy life style and good nutrition are very good ways to make it harder for these opportunistic viruses to affect us.
Bubble suits may help with some infections, but sometimes, as in the case of herpes simplex type one(cold sores) they just happen.
Carol
Carol,
I meant to include the disclaimer that I had no experience with or much knowledge about shingles, but I neglected to do so. I knew the mechanism of infection and transmission was the same as herpes simplex, that following the primary infection with chickenpox, the virus becomes latent in the sensory ganglia, where it can be reactivated from time to time. After a little research today, I can understand why you feel shingles is a “one-time thing”, because only about one in fifty shingles sufferers will have repeated breakouts, but it can happen. As this is frequently a disease of the elderly, maybe most do not live long enough for a second or more attacks. If you check, you will find that stannous fluoride is used for its anti-viral properties as well as its affect on tooth enamel. As you say, living well is the best prevention. I just learned that I must be a Republican (although I’ve never voted that way) because I read a democrat’s comment on the Republican Health Care Plan as “Don’t get sick, but if you do, die quickly.” This is exactly the way my father always said he wanted to live his life, staying healthy and far away from doctors until he “keeled over on the wood pile”.
Subvet416,
I think I used the word usually before the once in a life time case of shingles, but with medicine, illness, diseases, nothing can ever by exactly definitive. At least not as solid as taxes.
The shingles vaccine is supposed to be a once in a lifetime vaccination, but since the vaccine is relatively new, we have not had many years to see how long the immunity might last. For sure shingles does not have the reptition rate that other herpes viruse have.
You have a good thought about maybe we do not live long enough to get the second case. Lifetimes are expanding in years as we are better able to deal with chronic illnesses and hopefully can offer a quality of life that one can enjoy into the later years. The ‘Don’t get sick, but if you do die quickly’ statement is offensive to say the least. There has to be a way for this nation to be able to take care of our elders and insure a better quality of life for all. I have read articles now that say that our grandchildren will easily live past the age of 100.
Carol
thank you carol. my wife has had this awful occurance on her face, and in an eye. we visited an opthalmalogist for months and months. she is a 1%’er as was proven again with her face lift and allergy to the bandage used after that. lucky us. anyway, i will be seeing my primary care VA dr later this month and will ask for the zostavax shot. if i can’t get it there, i will resort to my private primary care for it.
Barrie and Subvet 416,
Some of my last comment to Subvet416 did not post for some reason. This type of communication may have some quirks. Herpes zoster of the face is the much rarer kind of shingles and in many ways more scary healthwise. The assitance of an opthamologist who has dealt with this is very necessary as you know. Hope all is well.
Carol
she is a trooper. somehow gets all these weird things, and somehow gets thru them. i just needed to respond.
http://www.naturalnews.com/027293_flu_vaccine_swine.html
(NaturalNews) Swine flu vaccine zealots are like zombies… they just keep coming at you, mindless… heartless… empty-headed and a tad funky on the smell, too. But I’ve noticed from observing the behavior of a few such zealots that not all of them fully comprehend precisely how to act like a mindless vaccine zealot. There’s more to it than just parroting whatever the FDA says.
Step 5) Remind people that they are not doctors and therefore don’t know anything. Then quote some doctor who’s pro-vaccine (and probably taking kickbacks from some pharmaceuticals.
http://politicolnews.com/topics/h1n1-vaccine-chemical-cocktail-of-death/
Some real facts about the Swine Flu Vaccine
-long term effects of the chemicals-aluminum
-long term effects of mercury-brain damage
-long term effects of aborted fetus tissues-genetic manipulation
-long term effects of squaline adjuvants-the very real fear of the 1976 Paralysis-Guillian-Barre-Disease.
-for pregnant moms-this could mean damaged or deformed babies or death.
-for older people-destroys their immune system causing death.
-for younger people-diseases such as cancer, diabetes, damaged immunity or death.
http://wwwcampfire.blogspot.com/2009/09/breaking-news_30.html
Mick,
People like you, who insist on perpetuating and spreading urban legends about medical issues do far more harm than good. All issues you have mentioned have long ago been addressed or acknowledged by medicine. When you spread disinformation you are not helping anyone.
There have been studies addressing mercury levels in children and hold onto your hat, children with autism have lower mercury levels than other children. Not higher, but lower. The reason for the lower levels of mercury is because they tend to be picky eaters and do not eat fish, which is where everyone, children and adults receive elevated mercury levels from. There has never been a correlation between autism and ethymercury (thimerosal).
Go to sites on the Internet that give real information and not scandalous, black news sites meant to keep you and others like you under the thumb of fear mongerers like Newsmax, Town Hall, and World net daily. Maybe you could even look at the actual rates of pandemic influenza in states and over the world and see the deaths adding up from those who have not been vaccinated. Even your local newspaper would address this issue.
The U.S. had not even begun to see the usual casualties from seasonal flu yet. You can choose or not choose to take any vaccines you wish. Vaccines can and have saved many lives (for instance the poliomyelitis vaccine) and will continue to do so.
Carol
I am not a Vet but work at a VA, just found out I possibly have shingles. A couple spots on my scalp showed up after a couple days of headache and tenderness on the scalp. I am getting tx. I have read a lot on it but no one addresses how contagious SHINGLES is, being around sick people, children, transplants, or elderly parents for that matter. My Dr didn’t advise me how long I should be away from work or patients etc. What is safest for me and my patients? Am I contagious only while I have lesions. DO they need to covered with a OR skull cap or can I just work in my office and not see patients. Or do I see patients but keep several feet away?
Louise,
Exposure to someone who has shingles (Herpes Zoster) can cause those who have never had chickenpox (varicella) to develop chickenpox. Keep your lesions covered as it is the liquid in them that spreads the virus. You are contagious only when you have the lesions. Herpes zoster, although a virus, is not spread by droplets in the air when one sneezes or coughs. Direct contact with the fluid will spread the virus. The doctor who treated you should have addressed this issue with you.
I hope this information helps and that you are on the road to recovery.
Carol
recent literature indicates:
a) it is possible to use a strong dosis of the OKA vaccine to boost immune response and prevent VZV reactivation
b) vaccination does not defo prevent zoster. it blocks varicella. (ref the case of latent infection by 2 different strains, i.e. people have acquired immunity but subsequently got infected again and did not have an outbreak of varicella but the new strain still established latency)
dont bother replying – i wont be back :/ – rather spend that time looking up those two references, alternatively check the supplementary issue 2 of the journal of virology 2008.
rgds
Have at it. Perhaps you should have really read the article.
Carol
sorry one more thing – wtf ? ur a health care worker – what do u think PCR assays are good for ? if u have shingles take proper measures and dont be around patients….. varicella is mild but complications can be a problem….
Carol, I was diagnosed with shingles at age 45 and recovered for quite some time. I am now 55 and suffer periodic breakouts. I suffered a mtbi at age 52 and since then have had several breakouts. Although my physicians do not agree, I believe I suffer from these breakouts due to the head trauma I suffered. I was knocked unconscious for approx. 3-5 minutes, and I suffer regular head pain (in trauma site)and the breakouts are linked to this. Are there any articles or medical information that would support what is currently happening to me?
Christal,
What I have been able to find out is that someone who has had Herpes Zoster has a one in three chance of a reoccurrence of herpes zoster after the initial attack. Apparently those who suffer more pain have an increased chance of reoccurrence. If you had a particularly painful first bout this could be why you continue to have subsequent ones.
The time between the attacks may be as little as about three months and as long as 10 years after the initial attack. Recurrences are more likely in those who have shingles related pain for 30 or more days during the first episode, incidence of recurrences are twice as likely with shingles associated pain for two months or more, was 60 % more likely in women than men, and 40 % more likely in those who are 50 or older when they had the initial attack. But there can be recurrences without any of the above associations.
Those treated for severe Rheumatoid arthritis are more prone to have an outbreak of Herpes Zoster than those who have milder forms. This is probably due to the medications they take to decrease their symptoms. Many of the medications work by suppressing the immune system and this fact would allow Herpes Zoster to flare up. Those who receive solid organ transplants, ie liver, kidney, etc. all receive medications so their bodies will not reject the new organ. These transplant patients often develop Herpes Zoster. Another reaction to immunosuppressive drugs.
As for your head injury causing the relapses, I cannot find anything definitive to suggest that. The head injury would have caused stress to your body. Perhaps stress can also trigger a Zoster outbreak. That would be the only connection I would be able to find. You do not mention what part of your body is affected by the outbreaks. If you had your original outbreak on your head in the area of where you were struck to receive your mild TBI perhaps the nerves in that area are involved. If your attacks are on your body, I do not think there is any connection other than the stress factor mentioned above or any medications that you might be taking or if your immune system is suppressed for any reason.
Carol