June 1, 2011

Shingles 101: A Public Service Message

By Stephen N. Maskaleris

The Centers for Disease Control and Prevention (CDC) has put out a seven-point program to inform the public about shingles, a painful and miserable medical condition. They want us to know:

•  One in three Americans will contract shingles

•  One million new cases occur each year

•  It only strikes people who have had chicken pox

•  Risks and complications rise with age

•  Symptoms include a blistery rash and nerve pain

•  It can cause vision and hearing damage

•  The vaccine cuts risk by about half

Shingles is such a devastating medical condition that the public should be made aware to hopefully avoid activating the virus that causes the condition. It is estimated that there are one million cases each year. Read on to get up-to-date about what shingles is, how painful it is, how best to avoid getting it, and what treatment options exist.

People don’t generally think about shingles until they contract it; then, it is the uppermost thing in their minds because of the pain and disability they experience from the condition.

Many prominent people suffer from shingles, including our friend Truman McNulty, a former member of the ABA Board of Governors and a popular SLD Council member who got sick with it in the later days of his life. He suffered such great pain and discomfort that no medication helped. He had difficulty sleeping, and he went from being a lively, active person to a shadow of his former self.

What Causes Shingles

WebMD describes shingles (herpes zoster) as a painful skin rash often with blisters caused by the varicellazoster virus, the same virus that causes chicken pox. In people who have had chicken pox, the virus is never fully cleared from the body. Instead, the virus remains dormant in the nerve tissues. When physical or emotional stresses weaken the immune system, the virus reactivates and spreads along the nerve fibers to the particular area of skin supplied by the involved nerve.

Burning or tingling pain, or sometimes numbness or itch, in one particular location on only one side of the body is often the first sign of shingles. After a few days, a rash develops. The pain from shingles is customarily described as “horrible” or “excruciating,” and up to 25% of the cases can result in permanently impaired vision or deafness.

Zostavax, the shingles vaccine, until recently had been recommended for adults 60 years of age and older to cut the risk of getting shingles in half or to reduce the severity of the pain after getting shingles. People who have had shingles can get vaccinated to help stop recurrences. In 2009, just 10% of adults 60 and older received the vaccine—far fewer than was originally hoped. Among those over age 79, the incidence of shingles climbs to 33%, and the nerve pain from the affliction lingers for months or even years after a rash occurs. Unfortunately, the vaccine is less likely to prevent disease in those over age 80. Side effects from the vaccine are redness, swelling, and pain or tenderness at the injection site most commonly, but reactions may also include fever, diarrhea, and flu-like symptoms. Rare but potentially serious problems affecting the heart, worsening asthma, or any other signs of an allergic reaction should be immediately reported to your physician.

Zostavax is not recommended for people who have had an allergic reaction to gelatin, the antibiotic neomycin, or any component of the shingles vaccine, for anyone with a weakened immune system due to leukemia or HIV/AIDS, for those receiving treatment for cancer or being treated with drugs that affect their immune system, like high-dose steroids, nor for women who are or might become pregnant within four weeks of getting the vaccine.

Many insurance plans, including Medicare Part D, cover the cost of the vaccination.

Shingles may develop in any age group, but you are more likely to develop the condition if you are older than 60, you had chicken pox before your first birthday, and your immune system has been weaked by medications or disease.

Shortage of Vaccine—A Worldwide Problem

Today, there is an acute shortage of this medicine. You are on your own to try to get it. According to a July 12 article in the New York Times, Merck managed to ship 2 million doses in the first half of this year, but Zostavax is once more in scant supply. The Federal Drug Administration has also just lowered the age that the vaccine should be used from 60 to 50, making getting the vaccine more competitive (even though there has not been a single year since the drug was licensed in 2006 that the supply has been plentiful, according to the CDC).

The virus is made with a live attenuated virus that is difficult to grow in bulk. Merck is spending $1 billion to increase production. A plant has been built in Durham, North Carolina, but it will not be fully licensed and operational until 2013.

It makes one wonder if lowering the age from 60 to 50 at the present time is nothing more than an exercise in futility. Those over 60 in particular should be warned to order the vaccine immediately. Their lives may depend upon it.

What SLD Members Say About Shingles

Harry Hathaway: “I had them many years ago at around age 60. Very painful, but nothing like kidney stones, or adult chicken pox, which I had around age 50.”

Ed Kallgren: “A colleague of mine has had them for some time. Apparently they can recur periodically, and he has been in extreme discomfort from the disease.”

Bruce Mann: “Three years ago I woke up on an overnight flight to a client meeting in Israel with excruciating pain around my waist, from front to back. After I got to my hotel, I called my (now former) doctor and described the pain and the rash and blisters accompanying it. He said, ‘You’ve got shingles. Come to my office.’ I said I was in Haifa and it would be two more days before I could get back home. He said he’d make time to see me when I landed. When I got to his office he said he’d give me an anti-viral but, because it wasn’t administered within three days of the rash first appearing, it probably wouldn’t help. It didn’t. I still suffer the pain of post-herpetic neuralgia every day. Of course I could have gotten the shot in Israel within the three-day window if I’d known what shingles was and how to treat it, but I didn’t, and I wasn’t told to see a doctor there before returning. The best way to prevent shingles is to avoid getting chicken pox; the next best way is to avoid stressful travel for clients. If you can’t avoid either, get the shot, know the symptoms, and act promptly if the symptoms appear.”

Seth Rosner: “I never had the shot, had the shingles. One summer when I was a boy, early teens. It wasn’t pleasant at all. Struck my upper chest and shoulder on the left side. Extremely painful, of a kind I’d not experienced before and since. Incapacitating in many ways. Don’t remember a great deal, likely because I’m suppressing very serious unpleasantness.”

Ed Schoenbaum: “I remember how much my mother suffered with shingles when I was in my early 20s.”

John Storer: “While hospitalized for another matter about 10 years ago, I experienced some mild back pain, which became uncomfortable. Mentioned it to doctors, who commented it was probably related to my condition causing hospitalization (heart problem). I had   a real serious heart condition prior to this (multiple bypass surgery), which sped up my withdrawing from the practice of law and retiring. In any event, my complaint was regarded as relating to my heart problems. About a week or so after my release from the hospital, the pain was still present more on an intermittent than steady basis. I also noticed a reddening about my right side and a few days later a rash appeared. The rash became more serious, as did the pain. I made a visit to the doctor and with one look he said, “shingles” and that it was too late for the shot. It was a messy rash that was very uncomfortable. It was treated with all kinds of medicines, salves, and patches. Can’t say with any good result—even to this day intermittent pain of a bothersome, sharp nature still occurs. It’s uncomfortable, but I’ve learned to live with it. The availability of a shingles shot was not publicized as highly then as it is today. Needless to say, knowing then what I know today, I would have stood in line for the shot.”

Many other SLD members have also related their painful experiences with shingles. Their comments can be obtained from the SLD offices, including a very fine two-page handout from Pharmacy at Safeway, from which much of the information for this article was obtained. 

Stephen N. Maskaleris is chair of the Health and Fitness Committee.