Shingles can strike without warning - Here’s how a vaccine may help

I had a mild case of shingles a couple of years ago, which started as an itchy red rash on my back that turned painful after a couple of days. I was treated with antiviral medication and the symptoms, including fatigue, lasted about three weeks. It was not an experience I would want to repeat.

Shingles is caused by a virus that remains dormant in people who were infected with the varicella zoster virus (chickenpox) in their childhood, according to Sarita Bajracharya, MD, an internist with Primary Care Internists in Hyannis.

“When the virus is reactivated in adulthood, it presents as a very painful skin rash on one side of the body that can blister and scab. The rash appears in a belt-like fashion around your body and the common areas for it to erupt are the trunk, back, chest or abdomen. Interestingly, the word ‘shingles’ evolved from the Latin word cingulum meaning ‘girdle’ or ‘belt.’”

To control my pain, I took Tylenol and rested as much as I could. What I didn’t realize at the time is how lucky I was that I didn’t suffer the painful effects of post herpetic neuralgia (long-term nerve pain) that can occur during and after a bout of shingles.

“I have seen cases of shingles in my practice that varied from mild to severe,” Dr. Bajracharya said. “One patient in his late 70s had shingles and was not vaccinated. He really suffered a lot with post herpetic neuralgia for more than six months. Another patient who was in her 40s and immuno-compromised following a transplant had a prolonged recovery period from shingles requiring anti-viral medication and antibiotics in addition to treatment with Neurontin for three months for her post herpetic neuralgia pain.”

While these two patients had prolonged symptoms and treatment, Dr. Bajracharya hasn’t seen any patients with shingles in patients who have been vaccinated in the past six years.

“My older patients are very proactive in getting all of their vaccinations,” she said. “The last patient I saw who had shingles even though they received the shingles vaccine had a very mild case and that was about six years ago. I reassured my patient that they had a milder illness and prevented neuralgia because they had the vaccine.”

Who Should Get the Shingrix Vaccine and When?

Dr. Bajracharya says this vaccine is recommended for:

• Everyone over the age of 50.
• Immunocompromised patients over the age of 18.

Anyone born in in the United States before 1980 is presumed to have had the chickenpox, she said. Those born after 1980 may or may not have had chicken pox and may have been vaccinated with the varicella vaccine. Whether you were born before 1980 or after 1980 and are unsure if you had chicken pox or were vaccinated with varicella, it is still recommended you get the Shingrix vaccine.

Anyone who is being treated for cancer, is taking immunosuppressant medications for conditions including rheumatoid arthritis, psoriasis, an organ transplant, bone marrow transplant or have an HIV infection, even if they are under the age of 50, should consult with their primary care physician, treating specialist or infectious disease specialist to inquire if they should receive the vaccine because they are at a higher risk of getting shingles.

If you get shingles and you are not immunocompromised (don’t have an impaired immune system), you can delay getting Shingrix for about one year because your natural immunity has been boosted by the infection, said Dr. Bajracharya.

A Word of Caution

“I know we all worry about vaccines because there can be side effects,” said Dr. Bajracharya. “Get your vaccine when you can take a couple of days to rest afterwards. You may have a little fever, pain at the injection site, fatigue or a headache and none of these symptoms will last longer than two to three days.”