Chickenpox redux -
Shingles unwelcome encore of childhood virus in elderly
BY DR. MINDY AISEN
If you had the chicken-pox as a child and are now older than 60, you are in the group most likely to get shingles, a miserably painful skin and nerve infection caused by a reactivation of the chickenpox virus.
Each year, more than 850,000 Americans develop shingles, also known as herpes zoster. About half of those who live to age 85 will get the disease - but only those who had chickenpox when they were young. The same virus that causes chickenpox causes shingles. When a young person recovers from chickenpox, the varicella zoster virus doesn't disappear - it "hides out" in clusters of nerve cells called sensory ganglia, next to the spinal cord. The immune system causes the virus to lay dormant for many years, but as the immune system weakens with age, the virus can reactivate, resulting in shingles.
Factors other than age can heighten the risk of shingles.
Those with compromised immune systems - such as people with AIDS or Hodgkin's disease, or those taking drugs that suppress the immune system - are more likely to develop the condition. Stress also can play a role in triggering the ailment.
Painful Symptoms.
When the virus reawakens, it travels through the nerves and to the skin. The first symptoms can be flu-like: fever, chills, headache, nausea, upset stomach. Some people experience itchiness, a tingling feeling or pain in the initial stage.Within a few days, a painful rash develops, usually on the chest, back or face. When the rash is at its peak, the pain can be intense and unrelenting. This rash develops into small, fluid-filled blisters that begin to dry out and crust over after about a week.
For most people, the disease will resolve itself even without treatment. And after one attack of shingles, the condition is unlikely to return.At the same time, treatment with antiviral drugs - especially within the first couple of days - is highly recommended, as it can reduce the pain and may help prevent a shingles complication known as postherpetic neuralgia. This condition results from damaged nerves and can continue long after the rash heals. While not life-threatening, it can develop into chronic pain that may bring with it insomnia, weight loss, depression and other medical problems.
Fortunately, only about 10 percent of all people with shingles develop postherpetic neuralgia, and in most cases the pain is not severe and goes away within a couple of months. Older patients, however, are at higher risk.In some cases, other complications of can occur. If shingles appears on the face, it can lead to vision or hearing problems. If the cornea becomes infected, the result can be permanent blindness.
Contact with an infected person does not cause another person's dormant virus to awaken. But the virus from a shingles patient may cause chickenpox in someone who has not had it before.
Study Under Way.
Shingles research is being conducted across the United States by VA, in cooperation with the National Institute of Allergy and Infectious Diseases. Researchers are testing Doug Rollison a more potent version of the chickenpox vaccine given to children to see if it can prevent the occurrence of shingles in volunteers who are at least 60 years old and who never had shingles before. The study has recruited some 37,000 volunteers at 21 VAmedical centers nationwide. Results from this clinical trial are expected within a year or so. If the vaccine proves effective, this will be a huge step in helping to prevent shingles for today's baby boomers and future generations. Dr. Michael Oxman of San Diego, the VA researcher coordinating the shingles vaccine study, has reported that seniors who regularly performed a Chinese style of exercise called "tai chi" for 15 weeks boosted their immunity to shingles, as measured in special medical tests. The study is considered the first randomized, controlled trial to have shown that behavioral changes can increase the immune factors that protect against shingles.
Mindy Aisen, MD., is deputy chief research and development officer for the Veterans Health Administration. Living Well is designed to provide general information. It is not intended to be, nor is it, medical advice. Readers should consult their personal physicians when they have health problems.
