“Once a person has chickenpox, the virus stays in their body. The virus can reactivate later in life and cause shingles.”
- Centers for Disease Control and Prevention
“Sen. Dianne Feinstein (D-Calif.), 89, developed encephalitis and Ramsay Hunt syndrome as complications of shingles…”
- CBS News (May 18, 2023)
In February 2023, shingles sidelined California Senator Dianne Feinstein. And complications of shingles—encephalitis (inflammation of the brain) and facial nerve involvement (Ramsay Hunt syndrome)—forced her absence from the Senate until mid-May. In today’s Germ Gems post, I provide a brief overview of shingles and discuss what you can do to keep it at bay.
The three faces of varicella zoster virus. Varicella zoster virus (VZV) is a highly contagious, wily DNA herpes virus that infects almost everyone by the time they reach adulthood. Clinically, it first makes itself known in childhood as an itchy rash called chickenpox (Face 1). (For more information see “Chickenpox: One of the Most Contagious Viruses Known,” August 25, 2021 Germ Gems post.) Most people become infected with VZV by aerosols released from skin lesions (vesicles). In many cases, however, VZV causes an asymptomatic infection, and the virus is held in check in a latent form by the immune system (Face 2).
If one’s immune system becomes compromised, VZV can resurface in the skin as a painful rash called shingles (Face 3). Aging (immunosenescence) is the most common condition that leads to reactivation of VZV. AIDS and certain types of cancer are other immunodeficiency states that commonly allow VZV to awaken from latency.
Shingles. Shingles—aka herpes zoster—is characterized by a painful rash. It is estimated that about 1 million Americans develop shingles per year. The disease gets its name from the Latin word “cingulum” meaning belt or girdle, because the small blisters that arise when VZV reactivates in nerves and surrounding skin assume a band or belt-like pattern following the distribution of the involved nerve.
In addition to the rash, other symptoms of shingles can include fever, chills, and headache. The pain associated with shingles can be severe—not uncommonly requiring an oral opiate for relief. Involvement of the eye can cause pain, drainage, redness, sensitivity to light, and permanent visual impairment.
Although the rash usually resolves on its own within a few weeks to months, treatment with an antiviral agent like acyclovir or famciclovir can shorten the duration of the disease. Your doctor should guide any treatment— especially if you are immunocompromised.
Fewer than 100 cases of fatal shingles are reported per year in the U.S. But shingles is not without complications. One of the most commonly feared complications of shingles is post-herpetic neuralgia (PHN)—pain lasting more than four weeks. PHN occurs in about 20% of patients with shingles and commonly requires strong analgesics for pain relief.
Other serious complications of shingles are infection of the brain (encephalitis) and of the facial nerve near the ear (referred to as Ramsay Hunt syndrome). Fortunately, these complications are quite rare. (One out of every 33,000-50,000 cases of VZV infection involves the central nervous system.)
Preventing VZV infection. Chickenpox vaccine became available in the U.S. in 1995. Today, about 90% of children in the U.S. are vaccinated against chickenpox by age two. (Children under age 13 years should get two doses of vaccine: First dose at age 12 through 15 months. Second dose at ages four through six years. It is uncommon for people vaccinated against chickenpox as children to develop shingles later in life.
Nonetheless, to bolster the immune system, the Centers for Disease Control and Prevention (CDC) recommends vaccination of all adults aged 50 years and older with Shingrix (a recombinant zoster vaccine) to prevent shingles and related complications. The CDC recommends two doses of Shingrix separated by two to six months.
Shingrix does not, however, protect everybody. The vaccine is reported to be 91% effective in adults who are 70 years of age and older. The CDC’s website (http://www.cdc.gov.shingles) is an excellent resource for more detailed information on “What Everyone Should Know about the Shingles Vaccine (Shingrix).”
Psychological (emotional) stress and shingles. Although there is very convincing evidence that sustained psychological stress can impair functioning of the immune system, most of this evidence comes from studies in animals. In the February 2023 article “Shingles and stress: Is there a link?” published in Medical News Today, the authors discuss the potential roll of stress as it may pertain to Senator Feinstein’s case of shingles.
In the article, several tips are given for coping with stress. These measures include exercising regularly, eating a balanced diet, getting enough sleep, spending time with family and friends, practicing mindfulness with gratitude, and learning to say “no.”.
When to speak with your doctor. Anyone who suspects they may have shingles should immediately consult their physician. It is important to get a diagnosis promptly in order to start treatment. The prompt administration of an antiviral medication can speed recovery, and medication (including, in some cases, a strong analgesic) may be required to ease the pain.
Equally important, shingles like chickenpox is highly contagious. If you contract shingles you should avoid contact with people who haven’t had chickenpox or haven’t received the vaccine until the vesicles of your skin rash are scabbed over.