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Sat, Dec. 14

Don't turn a cold shoulder to shingles

Shingles is an infectious and painful rash that typically affects people 50 or older (although any age can be affected). One million cases of shingles occur each year in the United States.

It is caused by the Herpes Zoster virus - the same virus that causes chickenpox in children and young adults. This virus is different from Herpes Simplex viruses 1 and 2 that cause cold sores and genital herpes.

How is shingles caused?

Chickenpox virus is typically picked up during childhood. After recovery, the virus remains dormant for many years in the spinal cord and some parts of the brain. The virus gets reactivated as the person ages or once the immune system weakens following development of cancer, leukemia, lymphoma or HIV, and after receiving large doses of steroids or anticancer drugs.

Then the virus spreads along the affected nerve and shows on the skin as red blisters that scab after three to five days. Before the rash develops, there is often pain, itching and tingling in the area where the rash will develop.

Other symptoms, such as fever, headache, chills and upset stomach may precede the illness. One in five people (the older you are, the higher the risk and the more severe it is likely to be) affected by the shingles develop a painful condition known as post-herpetic neuralgia which can last for weeks to months. Rarely, the disease leads to complications such as pneumonia, hearing problems, blindness and brain inflammation and death. Usually, shingles affects a person only once; occasionally, it could recur once or twice more.

How is it passed on?

A patient with active shingles could pass on the virus by direct contact to others who never had chickenpox; such people develop chickenpox and not shingles. The virus is not spread by sneezing, coughing or casual contact. The risk of transmission is highest during blister-phase (and not before or after) and rapidly declines after scab formation. Patients with shingles should keep the rash covered, avoid scratching it, wash their hands often and seek medical attention at once.

How is it treated?

Several medications such as acyclovir (Zovirax), valacyclovir (Valtrex) and famciclovir (Famvir) are effective in treating shingles. They should be started as soon as possible after the rash appears. Early treatment could shorten the duration and the severity of the illness. Pain medications are often used to treat any associated pain.

Shingles vaccine is licensed by the FDA for one-time administration to people 60 or older (regardless of history of chickenpox) to prevent shingles. There is no upper age limit. The vaccine is not useful in treating shingles or post-herpetic neuralgia. It will not prevent other forms of herpes such as genital herpes.

Before licensing, it was tested in 20,000 people aged 60 and older and it is considered safe. A live but weakened form of chickenpox virus is used in preparing the vaccine. The most common side effects from the vaccine include redness, soreness, swelling or itching at the injection site and headache.

Occasionally, a chickenpox-like rash may develop around the site of injection. It should be kept covered. Risk of transmission of the virus to people who are not immune to chickenpox has never been reported but is closely watched.

After receiving the vaccine, you can be around young children, pregnant women, cancer patients or people with a weak immune system. The vaccine is effective in preventing shingles in 51 percent and post-herpetic neuralgia in 67 percent of people who are vaccinated. The vaccine has been shown to be effective for at least six years following vaccination.

The vaccine can be given to people who have had shingles in the past no matter when. People who just recovered from shingles also could get vaccinated after complete resolution of the rash. You should not take the vaccine if you are allergic to gelatin, neomycin or any other ingredient of the vaccine; have a weak immune system because of leukemia, lymphoma or any other blood or bone cancer; have HIV with T-cell counts below 200; are receiving a high dose of steroids or cancer drugs; or are a woman who is or might be pregnant.

Natarajan Asokan, M.D., F.A.A.P. is a board-certified allergist and immunologist and a board-certified pediatrician with more than 25 years of experience as a physician and nine years of experience as a practicing allergist and immunologist. He treats adults and children with various allergy and immunology problems. He can be reached at 1739 Beverly Ave, Suite 118, in Kingman, or call (928) 681-5800.

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