What Seniors Should Know About Shingles

shingles

Did you have chickenpox when you were a child? Most of us over the age of 25 did, and most of us recovered just fine. In fact, most of us probably haven’t given it a thought in decades.

However, the varicella-zoster virus (VZV) that causes chicken pox continues to lurk in some of your nerve cells long after you’ve recovered. For the majority of people, this virus remains inactive and is generally forgotten about. For a third of adults, though, the VZV virus randomly wakes up and becomes active again. This second time around doesn’t give you another bout of chickenpox. It gives you shingles.

What exactly is shingles?
It’s a rather cute sounding name for such a nasty ailment. Shingles is a viral skin infection that causes a rash, but not just a minor red and itchy annoyance that can be quelled with over-the-counter cream. This angry rash appears in a band or strip on one side of the body, and can be extremely painful. It can also lead to further complications in older adults, especially those in their 60s up.

The first sign that you are coming down with a case of shingles is when you feel a tingling along your skin that progresses to pain. This area of your skin may become sensitive to touch. Most often this occurs on the left or right side of your torso, although it can pop up anywhere on your body including your face. A few days later, this stripe of pain erupts into a bumpy red rash that causes significant stabbing, burning or shooting pain. This is often accompanied by fever, chills and headache, and sometimes an upset stomach. The blisters can ooze, but will usually start to dry up and crust over after a week or two. The pain and discomfort, however, can continue for months, and scarring of the skin is not uncommon.

You can get shingles more than once, but it is rare to have it more than twice.

What cause the dormant virus to wake up?
What exactly makes the virus go from inactive to active remains a medical mystery for the time being, although plenty of research is being done on the subject.

Is shingles contagious?
Yes and no.

If you never had chickenpox as a child or are unvaccinated, you are vulnerable to catching the varicella-zoster virus from coming in contact with someone with an active case of shingles. However, you will get chickenpox rather than shingles from this first exposure. With chickenpox, the itchy blisters are scattered all over the body. You get the fever, chills and headache, but not the shooting nerve pain typical of shingles. While chickenpox can be relatively mild in children, adults who contract chickenpox in later life tend to have it worse. In older adults, it can be very serious.

If you have already had chickenpox or the chickenpox vaccine that came out in 1995, you won’t get shingles by being exposed to someone showing active symptoms. Whether or not you get shingles is a matter of the dormant virus reactivating within you for some unknown reason. So, to clarify, shingles is not contagious to people who have already had a bout of chickenpox, but that doesn’t mean you won’t someday get shingles.

According to the CDC, a person with active shingles can only spread the virus when the rash is in the blister-phase. You are not infectious prior to the blisters erupting, and once the rash crusts over you are no longer infectious.

Those who have active blisters from shingles should be considerate to the health of others by covering up their rash with nonstick sterile bandages and avoiding touching it. Wash hands frequently and stay away from vulnerable people including:

  • pregnant women who have never had chickenpox or the vaccine
  • infants, especially those who have a low birth weight
  • people with weakened immune systems, such as those on immunosupressive drugs, undergoing chemotherapy, organ transplant recipients or those with HIV
  • individuals who are particularly stressed, as this can lower their immune system and leave them more susceptible to a shingles outbreak

Why is shingles so serious in seniors?
The risk of developing shingles increases as you age. Older people often have a difficult time fighting off infections as they age. About fifty percent of all shingles cases are in adults over 60, and the chance of getting shingles becomes greater after 70.

Besides the pain of the rash and the unpleasant symptoms of fighting a viral infection, seniors can have some severe complications from shingles that should make you want to avoid it at all costs.

After the shingles rash clears up, some people are left with ongoing pain called post-herpetic neuralgia (PHN). The pain is felt in the region where the rash was. For some, PHN is the longest lasting and worst part of shingles. About 10 to 20 percent of people who get shingles will experience PHN, and the older you are when you contract shingles, the greater your chance of developing this PHN. This persistant pain can be quite debilitating, leading to depression, sleeplessness, anxiety and weight loss. Daily activities and self care can become challenging. Analgesics, anticonvulsants and antidepressants can reduce the pain and usually PHN will get better over time.

If you experience that mysterious pre-rash tingling on your face, seek medical help urgently. Having a shingles rash anywhere near the eye can cause lasting nerve damage and even blindness. Hearing loss, facial paralysis and even swelling of the brain can also occur.

Is there a treatment for shingles?
Antiviral drugs such as Acyclovir (Zovirax), Famciclovir (Famvir) or Valacyclovir (Valtrex) can help your shingles heal faster and reduce your risk of complications. These are most effective if you take them within three days of the rash starting, so see a health care provider as quickly as possible at the tingling stage.

In terms of managing pain and other symptoms of shingles, you can try colloidal oatmeal baths, cool compresses, numbing medications like lidocaine, medicated lotions and painkillers like acetaminophen, ibuprofen or codeine. Wear loose fitting clothes to avoid aggravating the blisters.

Prevention is worth more than a cure, and there are now two preventative shingles vaccines to consider. It is recommended that healthy adults age 50 and up get vaccinated with Shingrix, a shingles vaccine that is given in two doses, two to six months apart. An older shingles vaccine called Zostavax is being phased out, but is still in use for people over the age of 60 if for some reason they can’t have Shingrix.

Shingrix is recommended even if you have had shingles, received Zostavax or don’t remember if you had chickenpox.

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