At first, she thought it was a rash. Or was it a brush with a jellyfish tendril at the beach? Surely she would have felt the sharp, unmistakable sting of a sea creature, says Sally, a miserably uncomfortable 60-year-old grocery store clerk.

Donna Singer, 52, remembers “a line of needles” across the top of her bra line. She was a 19-year-old college student at the time, planning a wedding between final exams and stressed “to the max.” A few days later, blisters appeared. She considers herself lucky—her episode was short lived and has never reappeared. Her 48-year-old sister-in-law’s outbreak landed her in the emergency room with searing pain and high fever. Residual pain has lasted for months.

Shingles, one of nature’s crueler jokes, is a resurfacing of the chickenpox virus.  And the older we get, the greater the chance we’ll experience an outbreak.

That is, until we’re old enough to qualify for the new vaccine against shingles. After reviewing a nationwide four-year study, the FDA has approved a shingles vaccine for persons over 60 who have not had shingles.

Vaccine to calm our ‘inner-child’

Shingles, the physical unfinished business of childhood, comes from your long-ago chickenpox outbreak.  Stress, immune dysfunction, surgery, possibly sunlight or age can activate a shingles outbreak that means blisters, lingering pain and intense itchiness. While the blisters may last only three to four weeks, the pain can persist for months to years. Anyone who has had chickenpox is at risk for shingles (though it doesn’t work in reverse). Across the U.S. an estimated one million people each year have a shingles outbreak.

Stephen Tyring, M.D., Ph.D., clinical professor of dermatology, with appointments in the Departments of Microbiology and Molecular Genetics and Internal Medicine, was an investigator at The University of Texas Medical School at Houston for the study of the newly approved vaccine. In the study 38,000 people at 20 sites were given the vaccine.

“While many people may not remember having chickenpox, more than 90 percent of the population has had the disease.” He explains that in the national study, 6,000 people reported that they had never had chickenpox. When this group was tested, the virus was actually in their bodies, and they were, therefore, at risk for shingles.

What is shingles?

Shingles occurs when the dormant varicella-zoster virus (chickenpox) is roused from its sleep. Like other viruses in the herpes family, it presents with pain, itching or tingling around a nerve ending at such sites as the base of the spine, the face, neck or torso, followed by an outbreak of blisters.

“The virus lies dormant in your system until you have an accident, an emotional challenge, dental work, or you experience some other physical or emotional stress that triggers a shingles outbreak,” says Tyring.

In 25 to 50 percent of people over 50, shingles pain will linger for months, or years, long after the rash and blisters have gone away. This condition is called post-herpetic neuralgia.

Not your average vaccine

Unlike most vaccines such as flu, measles or chickenpox, this vaccine boosts your immunity against a virus that already resides in your system. A weakened form of the chickenpox virus is reintroduced to the body, thereby boosting the immune system to reduce the chance of shingles occurring or lessening the severity of the outbreak should it happen.

Infectious disease specialist Luis Ostrosky-Zeichner, M.D., assistant professor of medicine at the UT Medical School, says that if you haven’t had chickenpox, you will not get shingles. However, if you have never had chickenpox, you could contract it through contact with shingles lesions and blisters—a danger to caregivers.

“Chickenpox is much more severe in adults, and, if a healthcare worker gets chickenpox, they are then at risk of getting shingles,” says Ostrosky-Zeichner. He adds that caregivers should be tested to see if they have ever had chickenpox and if not, they should get the chickenpox vaccine.

For this generation of children who have been vaccinated against chickenpox, Tyring says that though they also face the risk of shingles in later life, the incidence is much lower.

“Long-term follow-up of Japanese adults who received the chickenpox vaccine as children in the ‘70s show a much lower incidence of shingles in later life,” Tyring says.

The shingles vaccine has not been studied for people who have had an episode of shingles or those under 60. Tyring says that the chance of a recurrence of shingles is only 5 percent.

“While it will be difficult to show that vaccinating someone who had shingles in the past could reduce the chances of a recurrence below 5 percent, we are currently providing the vaccine to people at least 50 years of age who had shingles at least five years ago in order to determine if the vaccine will boost their immunity against the virus,” Tyring says.

The vaccine is not recommended at this time for people who have compromised immune systems from AIDS, cancer or other health problems.

Side effects are slight with possible localized tenderness or low-grade fever. Tyring considers the vaccine to be safe but adds, “You can never say it is without any side effects.”

Last Updated: 7-19-2006

 

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