Everything you need to know about shingles

For Françoise Fontaine, acne was but a long-ago memory of adolescence. Yet there it was, unmistakable, little red bumps in a straight line across the Paris resident’s forehead that a friend noticed after a day of shopping.

It must be an allergic reaction to the clothes I just bought, she thought. But just in case, Françoise called her long-time doctor the moment she got back home and described her symptoms.

“I think I know what you have,” the doctor told her. “There’s no need to panic. My assistant will bring you antiviral medication, which you should take right away, and go see an eye specialist as soon as possible.”

The next morning, Fontaine was sitting in the specialist’s office, shocked as he informed her she had a virus called shingles, also called herpes zoster, or zona in French.

"No matter what I try, the pain persists to this day"

“It occurs when a virus called varicella zoster, which causes chickenpox, reactivates,” he explained.

Unbeknown to Fontaine, the virus had been lurking in the nerve endings of her spinal cord ever since, dormant, waiting to catch her immune system off guard before pouncing again. She also didn’t realise that, while the rashes and blisters fade, the tingling and burning from what’s called post-herpetic neuralgia—or nerve damage—can carry on with little respite for some patients.

Six years later, Fontaine, now 86, says, “I was lucky. The outbreak didn’t affect my eyes. But no matter what I try, the pain persists to this day. In that way, I guess I’m not so lucky.”

Most shingles outbreaks last no more than a week or two, but some patients are at greater risk of developing life-threatening complications, including those who are undergoing treatment for cancer.

Research released in December last year found that a severe case of shingles can raise the risk for stroke and heart attack—and kill. Caroline Minassian, PhD, along with colleagues from the London School of Hygiene and Tropical Medicine, looked at the records of over 67,000 patients who had shingles and suffered either a stroke or a heart attack within a year.

“We observed a 2.4-fold increase in the ischemic stroke rate and a 1.7-fold increase in the heart-attack rate,” said researchers. “The most marked increase was observed during the first week following zoster diagnosis.”

Researchers suggested two possible causes: the virus causes fatty build-ups in the arteries to break off and cause a stroke or a heart attack, or the stress caused by the pain sends blood pressure up, again resulting in a stroke or a heart attack.

Further research into shingles at the Mayo Clinic in Minnesota also reported in December last year, showed that adults with asthma appeared to have a 70 percent higher risk of developing shingles, compared with those without asthma.

If you notice symptoms of shingles, it's important to contact your doctor straight away

It’s a name that comes from the Latin and French words for “belt” because it often appears at waist level, partly circling the body.

Dr Allison McGeer, a microbiologist at Mount Sinai Hospital in Toronto enumerates the symptoms, which tend to occur on one side of the body because usually only a single nerve root is involved.

These may include numbness or tingling, itching, fatigue, headaches, high fever, a sensitivity to light and excruciating nerve pain that can upend your life, leaving you sleepless, unable to work or carry out daily activities.

“As you get older, your immune system stops paying attention to the virus for a period of time so that it grows down the nerve root, unimpeded,” McGeer says. “The resulting skin rashes have distinctive shapes because they follow the pattern of the nerves as they give feeling to our skin.”

If you’re exposed to someone with shingles, you won’t get the virus as long as you’ve had chickenpox, says McGeer. But if you’ve never had chickenpox and are exposed to a person with shingles, you may come down with the childhood disease.

Timo Vesikari, a professor of virology at the University of Tampere in Finland, and director of the institution’s vaccine research centre, says most people will have only one shingles outbreak in their lifetime be-cause it serves as a reminder for the immune system to become vigilant again. Still, depending on how old you are when the first outbreak occurs, it’s possible to have a second one and maybe even a third.

With life expectancies in Europe and North America longer than ever before, and with the baby-boomer generation well into shingles territory, doctors are girding themselves to see more cases than ever before. Says Vesikari, “Think of it this way—if we all lived for 200 years, then everyone would develop shingles at some point.”

Given that one in three adults over 50 will develop the disease, it’s best to prevent an outbreak in the first place. “For this, you have to get a vaccine,” Vesikari says.

If you’ve not been vaccinated, then you need to act quickly at the first sign of symptoms, as the antiviral medication is best used within 72 hours of an outbreak. This is especially important if you are hoping to mitigate the very painful post-infection pain that can often occur. 

Zostavax is the only vaccine currently on the market

Right now there’s one vaccine on the market. Called Zostavax, it has been approved for use in Europe and North America for the past ten years, and has been proven to reduce the chance of an outbreak overall by 64 per cent. But with ingredients such as live chickenpox virus, it’s difficult to produce in large quantities.

The result is that a single shot costs about £140. Although pricey, it been part of NHS recommendations for people between the ages of 70 to 78 for the past three years. But these ages are rather arbitrary as even younger people—even, in the rare instance, children—can develop shingles, and government health plans don’t cover the cost of the vaccine for them.

But once vaccinated, experts still don’t know for how long it’s effective, though five years is thought to be the limit. So if you do get vaccinated in your 50s or early 60s, it’s important to talk to your doctor about if and when to get a second vaccination. If you’ve had shingles, there’s no need to get vaccinated as your immune system has already been jump-started by the disease.

"With a new vaccine possibly just around the corner, shingles may not pose a problem at all in the future"

When to be vaccinated or revaccinated may soon no longer be of concern. In the near future—maybe early next year—a new vaccine should make it to market. Tentatively called Shingrix, experts in Europe and North America are excited because throughout every research phase, it has proved at least 90 percent effective in adults 50 and older.

The research trials, which took place in a number of countries, involved more than 16,000 patients aged 50 and older, with some well into their 80s. The results are promising, with no evidence so far of the vaccine’s efficacy diminishing over time.

Shingrix doesn’t contain a live virus. Instead, it combines an easily replicated protein found in the virus with an adjuvant, or chemical substance, that helps the body’s immune system wake up. Adjuvants are already used in vaccines to prevent a host of conditions, including hepatitis A and B, diphtheria and tetanus, but this is the first time one has been used in the battle against shingles. 

GlaxoSmithKline, the vaccine’s manufacturer, is expected to submit its findings to the US Food and Drug Administration later this year for approval, and afterwards to the authorities in Canada and Europe.

With a new vaccine possibly just around the corner, shingles may not pose a problem at all in the future. Says Dr Allison McGeer, “Assuming the vaccine passes all the safety hurdles, this is a very good news story.”

Read the full feature in the July edition of Reader's Digest

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