Saturday, February 02, 2008

Who needs a shingles shot?

Leftover chickenpox can cause a world of trouble.

My 59 year old patient was miserable. I saw her two days after the onset of painful blisters on her ear and in her ear canal. Besides the discomfort, she had terrible bouts of vertigo, and her mouth drooped on the same side as the blisters. "What is it?" I asked neurologist Adam Wolff, MD by phone. "Ramsay Hunt Syndrome," he answered, kindly not adding the word 'obviously.'

Nearly all of us of a certain age have done battle as children with the herpes zoster virus. Way back when, we broke out in the characteristic bite-like rash of chickenpox. Since then, we have carried the residual zoster virus-particles in our nerve cell bodies along the spine and the base of our brain. Our immune system has kept a lid on the little buggers who now wait for an immune lapse so they can break free of surveillance and multiply along the axons of the nerves. When they do, we will develop a painful blistering rash in the area of skin supplied by the affected nerves, and, occasionally, paralysis in the facial muscles or other neurological syndromes such as Bell's Palsy or this Ramsay Hunt business.

While immune problems from cancer, chemotherapy, AIDS, or steroid therapy increase our risk of shingles, just ourselves growing older are at elevated risk. And the older we get, the more likely we are to develop complications with shingles, in particular a prolonged pain syndrome known as post-herpetic neuralgia (PHN) that can last for months to years past the breakout.

Researchers from the Mayo Clinic sorted through scores of medical records from adult Minnesotans to determine the incidence of recurrent herpes zoster (HZ) illness in both the healthy and immunocompromised residents of the area prior to the availability of the shingles shot (Zostavax). Most Minnesotans with HZ troubles were free of immune troubles, succumbing to shingles at a rate of 4 per 1,000 each year. The older the subjects, the more likely they were to let loose their resident HZ and suffer from painful complications. Specifically, 68% of the affected group were 50 and over, and 1 in 4 of them developed HZ-related complications.

So who needs a shingles shot? It is specifically indicated for persons over 60 who wish not to suffer from PHN in their golden years. Trust me, my patients with PHN find those years of pain not so very golden. While it is not yet tagged for persons between 50-59, this younger group of oldsters could benefit as well. The problem for them, for now, is that insurance may not pay for this pricey shot until the FDA approves the vaccine for that age group.

30 comments:

JeanMac said...

Thanks again for an informative post - I'm asking my MD - I would gladly pay for the protection.

"his-self" said...

Great info. I too will ask my Doc about this. I've already had an outbreak about 3 years ago. It wasn't too bad but I'm now over the age threshold.

Femail doc said...

His-self: I believe that having a fairly recent outbreak of shingles is equivalent to having the shot with respect to boosting your immunity. Ask your doctor--I'm not so sure you need Zostavax at this time.

Mauigirl said...

The shingles-chickenpox thing is always confusing to me. Is there a difference between the relatively new vaccine for chickenpox, which is now given to children, and the new Shingles vaccine? Wouldn't it be the same since they're the same virus? Is it a difference in the dosage? I'd be interested to know, thanks!

Femail doc said...

MG: Zostavax for adults uses the same attenuated (weakened) live virus strain as Varivax for children. The adult version, however, is 14 times more potent.

Mauigirl said...

Thanks for the explanation! I was wondering how that worked.

If you're still reading comments down this far, perhaps you can confirm for me whether or not an adult who had already chickenpox in her distant past could come down with shingles if she is exposed to chickenpox? Or would that only happen if she had never had chickenpox? And in that case, if exposed to chickenpox, would she get shingles or chickenpox?

The reason I ask is my mother-in-law got shingles (this was about 15 years ago) after she had been to a baby shower where there were a lot of kids running around, and she always swore it was from being exposed to a kid with chickenpox. I said no, it was from stress (she was taking care of her mother who had Alzheimer's, at the time as well).

I was never able to find out whether what she claimed was possible or not!

Gloria Carter said...

I had shingles Feb 2004. On the front and back of neck, plus ear on the right side. I had breast cancer on the left side in 2002, plus radiation.
The question is it good for me the have the shingles shot?
I also had Bell's Palsy in 2006.

Femail doc said...

Gloria, I just read new guidelines yesterday on the shingles shot. Getting the shot whether or not you had shingles (or, I assume, Bell's palsy) a definite yes. With those two episodes so close together--shingles in '04 and BP in '06--I should think you could use any boost to your varicella virus immunity that you could get.

Femail doc said...

MG: I never answered your second question. An adult cannot get shingles from a person with chickenpox; shingles develops from one's own resident chickenpox virus not from new exposure. If she'd never had chickenpox, it is chickenpox that she'd get.

That said, in my experience, shingles outbreaks often seem to follow stress. So caretaking plus a baby shower full of noisy kids seems the perfect storm to bring on the shingles.

janeywan said...

Remember me?

I came snooping around figuring you had a post regarding shingles. Right I was. I'm being treated for shingles, have no rash thus far, just skin pain on the left side, mid section.

I guess it's preventive measures we're taking at this point.

Marilyn said...

What are the side effects of getting the shingles shot, if any. My doctor suggested that I should think about getting the shigles shot since I am now 61. Thank you

femail doc said...

JW: Long time, no see. Nice to hear from you again. I was thinking of you recently when we took a road trip near your neck of the woods. Sorry to hear about incipient shingles; I hope proactive treatment saves you from the actual outbreak.

Marilyn: We haven't had anyone complain about side effects. I imagine sore arm likely (no one has said that it's a show stopper, though), and because it's an attenuated virus, you might theoretically get a bit of an achy fluish sort of feeling as your immune system gears up to make the appropriate antibodies. I think a shingles shot is a great alternative to shingles!

Anonymous said...

So the shingles shot can be taken even if on has already had bouts of shingles? I was told-not by a professiona l- that it works like a vaccine and therefore cannot be taken once shingles have occurred.

Jennifer Zapp said...

I had Ramsay Hunt Syndrome 7 years ago and still have residuals like facial paralysis and balance issue. I am now much more healthy (yoga, stress reduction, diet). Do you know if it would be ok to get the Zostavax vaccine?

femail doc said...

Anon: Whether or not one has a history of shingles, when one has had chickenpox, the herpes zoster (HZ) lives on in the body. The shingles shot is a live, attenuated vaccine meaning it's been made from HZ virus that's been altered to make it harmless i.e. unable to cause disease. The vaccine does, however, boost one's immunity to HZ virus so we become better at keeping our own HZ virus from breaking free of surveillance and causing shingles. Of course you can not only take the vaccine, but it is recommended that you do even with a history of shingles.

JZ: Unfortunately, it sounds like you've had some 7th and 8th cranial nerve damage from your Ramsay Hunt Syndrome. There is no reason why boosting immunity to HZ virus should aggravate your residual symptoms.

Tina Good said...

Questions:
1) Is it a good idea to get the shot if one currently has shingles? (Under the theory of "Can't hurt; might help"?)
2) Is it a good idea to get the shot if one currently has fibromyalgia? (Among other things, over-sensitive pain nerves over the whole body - similar to shingles)

femail doc said...

Tina: I don't think a shingles shot will help when you currently have it as your immune system is already being boosted against the HZ virus from the infection. I don't think it would have any effect on fibromyalgia as the shot causes you to create antibodies against the HZ virus but has no effect on pain perception.

mespinosa said...

How long should I wait after chemo to receive the shingles vaccine? I'm 60 yrs. old. In Dec. 08 I completed 5 mos. of chemo (ACT)for breast cancer. Had previous bilateral mast., no radiation. Now taking Aromasin for 5 yrs. post-chemo. Also taking prednisone for polimyalgia rheumatica: began at 15 mg/day, now 6 mg/day, continue to reduce amt. by 1 mg/month.
Thank you very much.
mespinosa

femail doc said...

Ms. Espinosa: congratulations on ending your chemo treatment. Two problems with shingles shot and chemo: 1) It is a live virus and you don't want to expose yourself to that with a compromised immune system. I should think you're past that problem. and 2) You need to be able to mount a robust immune response to the vaccine to get immunity. I don't know how long post-chemo that would take. The prednisone would affect also these issues. Your oncologist and rheumatologist probably have some thoughts on these matters.

Anonymous said...

My husband has shingles. I treat hm every day with vaseline. I always wera gloves.I am going to get the shot, but wondered if having heart problems would cause any complications.

femail doc said...

Anon: I should think you'd be fine with a shingles shot; ask your doctor to be sure.

Sally7 said...

I had the vaccine administered last week. He did not put the needle into a muscle, just inserted under the skin on my upper arm. Is this the norm? I feel relieved I am protected.

Melissa said...

I have a couple of questions. I am 19 years old and have no other medical problems, but I have had shingles 5 times already, Would the shot be a good idea for me? and what would be some of the side effects of taking the shot

femail doc said...

Melissa: Five times!!! Good heavens, what a drag. You must not have a good immune response to this particular virus. I don't see a problem with the shot for you with respect to side effects, but I wonder if even the shot would boost your ability to fight off another attack. Seems to me like a good thing to try, what does your doctor say?

femail doc said...

Hi Sally, Yes the shot is given subcutaneously, i.e. under the skin.

Rose Price said...

I am 64 years old and had the vaccine in January of 2011. In March a rash broke out on my neck. Since then I have pain in my neck. Could this be a reaction to the live virus?
Rose

Anonymous said...

Had my shot about 3 months ago. My doctor said that shingles can be as bad as cancer in some situations. My insurance company paid the cost.

Anonymous said...

I was told a person receiving the shingles shot can not be in contact with a toddler under 1 for 2 weeks nor can you go to a nursing home. Is that true?
Thank you!
Nancy

Flower Child said...

Anon, my pharmacist said we shed the zoster virus for up to six weeks after getting the vaccine shot. That could infect those who have not had chicken pox before, and that can be very serious for the very young, pregnant women and the elderly.

I had Ramsay Hunt Syndrome in March 2008 and am still dealing with the residuals. I firmly believe that if I had been properly diagnosed (misdiagnosed as BP and Cellulitis)and given the right dose of meds, my case would have been milder.

Mary Ozee said...

I had such a light case of chicken pox when I was seven that only one pock (is it pock?) appeared. I actually thought it was a mosquito bite. Now, I'm old: 70. I have times when I feel as though a heated cheese grater is being used on the side of my face or on my thigh or buttock. My sister says this is incipient shingles. I suspect she is right, but how do I find out for sure?