Dear Doctor: My daughter took her kids to the pediatrician the other day for their chickenpox vaccinations. Now, because I had chickenpox as a child, she's after me to get a shingles vaccine. What is shingles, and what's the connection to chickenpox?
Dear Reader: The same virus that causes chickenpox is responsible for shingles, a painful rash that can cause long-term problems. It's possible to get shingles at any age, but it's most common in adults 60 and older.
Here's what happens. Once the fever, rash and body aches of a bout of chickenpox have ended, the virus that caused the illness, called varicella-zoster, stays in the body. It lies dormant near bundles of nerve along the spine, known as the dorsal root ganglia. These are the nerves that pass sensory information -- a touch, a tickle, the pain of a bee sting -- from your skin to your brain.
Years after the initial infection, for reasons that still aren't entirely clear, the virus can become active again. As it begins to reproduce, the body reacts. Some people get flulike symptoms such as headache, sensitivity to light and a general feeling of illness. Others notice their skin is becoming tingly, itchy or painfully sensitive.
When the shingles rash appears, it's generally along only one side of the face or torso. It can look like a stripe, as it traces the path of the affected nerves. Tiny blisters form and re-form on the skin, and last for two to four weeks.
During this period the person with shingles is contagious. He or she can pass along a case of chickenpox -- but not shingles -- to anyone without immunity. The virus can be spread by direct contact with fluid from the rash. That's why anyone with shingles should steer clear of pregnant women, infants, unimmunized children and individuals with suppressed immune systems.
If shingles sounds like a difficult and unpleasant illness, you're right. During a case of shingles, even the touch of fabric on the affected skin can cause pain. The most common side effect is a condition known as postherpetic neuralgia, in which the severe pain of shingles persists for months or even years.
The good news (we imagine that you're ready for some about now) is that there is a shingles vaccine. It's made of live varicella-zoster virus that has been greatly weakened. It's enough to stimulate an immune response in your body, but not enough to cause problems in anyone with a healthy immune system.
We routinely recommend to our patients who are 60 or older, and whose immune systems are in good order, that they get a shingles vaccine. Protection lasts about five years. Some drugs, such as those for rheumatoid arthritis, as well as some cancer drugs, suppress the immune system. In these cases, the shingles vaccine should be avoided. There are other contraindications as well, so talk it over with your primary care physician to make sure a shingles vaccine is the right decision for you.
For those who do get the vaccine, it's important to note that it doesn't guarantee you will never get shingles. What it does is measurably lower your risk. And if you do still get shingles, the vaccine also reduces the likelihood of developing postherpetic neuralgia.
Eve Glazier, M.D.,
and Elizabeth Ko, M.D.