Shingles: New Drug Helps Prevent Its Occurence

Those who had chickenpox more prone to the condition

By Eva Briggs

Chickenpox. Where did that name come from? The prevailing theory is that the individual spots resemble garbanzo beans, a.k.a. chickpeas. There’s been a vaccine available to prevent chickenpox since 1995. If you are 55-plus, there’s a good chance — almost 100 percent — that you had chickenpox long ago, probably during childhood.

Even though chickenpox goes away within a week or two, the varicella-zoster virus that causes it hangs around indefinitely. It lies dormant inside clusters of nerve cells called neurosensory ganglia. They’re involved in detecting pain and are located in the spine or in the nerves of the face and head.

Like Sleeping Beauty, this virus remains in suspended animation for years. Even without the kiss of a handsome prince, the virus sometimes wakes up.

When it does wake up, it travels from its bed in the nerve ganglia, down the adjacent nerves, and to the skin or other structures normally served by that nerve. There it replicates itself, forming new virus particles that erupt in a painful rash called herpes zoster — or shingles.

What stimulates this awakening? Scientists don’t know for sure. It appears to be related to declining cellular immunity. That’s the defense against infection carried out by cells, rather than by circulating antibodies.

Shingles certainly occurs more frequently as people age and their cellular immunity naturally declines. It’s also more common in people whose immune systems are compromised by infections like HIV or by chemotherapy drugs.

Do other factors contribute to shingles outbreaks? Stress, perhaps? Probably, but doctors don’t know for sure. I seldom know why a particular patient experiences a shingles outbreak at a particular time.

Shingles often starts with a prodrome, a cluster of symptoms that precedes the rash. Patients may have fever, headache and a general feeling of illness called malaise. Next comes pain, on one side of the body, localized to the area served by the affected nerve. People often describe the pain as burning, sometimes with itching. The area can be hypersensitivite to touch. It may be so severe that it disrupts sleep. In the right location it can mimic a kidney stone or heart attack.

Within a few days most people develop the typical shingles rash. Like chickenpox, the individual lesions start as red bumps called papules. These quickly turn into small blisters filled with clear fluid, termed vesicles. The vesicles progress to pustules when the fluid turns cloudy. Finally, the pustules break open and crust over.

The entire rash is almost always localized to a single dermatome, the skin area served by the ganglion that initiated the outbreak.

Shingles lesions contain live varicella-zoster virus, which can be transmitted to people who have never had chickenpox. When that happens, the susceptible patient comes down with chickenpox, not shingles. Shingles only occurs in a person previously infected by the virus, when that patient’s own personal store of virus is reactivated.

Shingles is much less likely to spread chickenpox than chickenpox disease itself. There are far fewer virus particles in the blood and secretions of a shingles patient than a chickenpox patient. Still, as many as 15 percent of exposed susceptible people contract chickenpox when exposed to a shingles patient.

So anyone with shingles must avoid people who have never had chickenpox, never received the chickenpox vaccine or who have a weakened immune system.

When diagnosed early, antiviral medicines (acyclovir, valacyclovir and famciclovir) shorten the course of the disease and reduce the risk of complications.

The most common complication is postherpetic neuralgia, pain that lingers at the site of the outbreak long after the rash resolves. This can be very severe, but may respond to a variety of medicines. One dangerous complication is damage to the eye. This can happen when shingles affects the nerves that go to eye structures. This may permanently damage the eye. Anyone with shingles that affects the area near the eye or causes eye symptoms needs to see an ophthalmologist.

Zostavax, the first shingles vaccine, was licensed in 2006 to prevent shingles in people aged 60 and older. It was billed as cutting the risk of shingles by about half, and lowering the risk of post herpetic neuralgia by two thirds.

But there’s a new kid on the block, Shingrix, as of October 2017. What’s good about it? It lowers the risk of both shingles and postherpetic neuralgia by about 90 percent. So it’s much more effective than Zostavax. Shingrix does not contain any live virus. And it can be given at age 50; the recommended age for Zostavax is 60. That’s good news since the risk of shingles starts rising by then.

The downside is that two doses are needed. And because it stimulates a more robust immune reaction, there are more side effects. Your arm is more likely to become red, swollen and sore. Many people get headaches, fatigue and achiness that may last a few days – severe enough to interfere with usual activities in 10 percent of patients. But it still beats contracting shingles.

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