Shingles: an update

Tweet Many years ago I heard Herpes Zoster - more commonly known as Shingles - described as "A belt of roses from hell", and it goes someway to describing the awful pain that shingles can cause. Herpes Zoster is the very same virus that causes chicken pox in young people. The natural history of the disease is that the child gets chicken pox, recovers and develops an immunity to the virus. The virus, meantime, lurks in for decades in the sensory cells of the spinal cord, unable to leave because of the circulating immune cells that are primed to kill it should it try to leave. However, as we get older, our "cell mediated immunity" declines, and at some point it may dip low enough to allow the virus to leave the sensory cells that it has inhabited and travel down the nerve attached to those cells, causing the classic rash eruption in the area of skin supplied by that particular nerve.

So what do we know about Shingles?

• It is an illness of older age: prevalence increases over the age of 60: the estimated lifetime risk of shingles is 20%-30%.
• Contrary to popular belief you can get it more than once: in fact the recurrence rate is about 6%.
• Shingles is preventable. There is a vaccination for Herpes Zoster that not only reduces the risks of developing shingles, but will also reduce the impact of Post Herpetic Neuralgia - the terrible pain that can linger for many months after the rash has abated. 
• The risk for clinically significant pain persisting for longer than 90 days is 14% in people with Zoster, aged 60 years and older.
• Prevention is far more efficient and effective than trying to relieve Shingles. The powerful medications used in the attempt to alleviate the pain and distress of Shingles also can have powerful and unwanted side-effects too.
• Vaccination is recommended for all non immunocompromized people over the age of 60, subject to appropriate advice from their treating physician.