How do you get shingles and who should be vaccinated against it? 24

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From November 1, the shingles (herpes zoster) vaccine will be available for free to people aged 70 to 79 years. Shingles is a dreaded and common disease of the elderly; let’s look at how and why you get it, and who should be vaccinated.

What is shingles?

Shingles occurs due to a reactivation of the varicella-zoster virus that lies dormant in the skin nerve roots after causing the childhood disease chickenpox (varicella) decades earlier.

Shingles typically shows up as a painful, blistering skin rash in a band of skin supplied by a single nerve (dermatome) on one side of the body. Pain often precedes the rash by a few days; sometimes leading it to be mistaken for other conditions.

The shingles rash is often painful and blistering.
CLS Digital Arts/Shutterstock

Pain at the site of the shingles rash that persists for months or years is the most common debilitating outcomes of shingles. Known as post-herpetic neuralgia (PHN), this pain can be continuous, shooting, or triggered by a light touch, such as from clothes or a gentle breeze.

There is no cure for PHN, and it is difficult to relieve in more than half of those affected, despite the use of multiple and complex pain medications. Even if shingles is treated early with antiviral and pain medications, PHN can occur.

Another common complication is herpes zoster ophthalmicus, which affects the skin around the eye and can threaten the person’s vision.

How common is shingles?

Almost all Australian adults (more than 95 per cent) have been infected with varicella-zoster virus (even if they can’t remember having had chickenpox) and are therefore at risk of shingles.

Advancing age is the greatest risk factor for developing shingles. As we age, our cellular immunity necessary to suppress the virus within us declines.

Around one in three people will develop shingles during their lifetime and each year about 20,000 Australian adults aged 70-79 years age are affected.

The older you are when you get shingles also increases your likelihood of developing complications. PHN occurs after shingles in approximately one in every ten cases in those aged 50–59 years, but climbs to one out of every five cases for those in their 70s.

People who have a medical condition or treatment (such as for cancer) that weakens the immune system are at greater risk of developing shingles, irrespective of their age.

The shingles vaccine

The shingles or zoster vaccine (brand name Zostavax) is composed of a live but weakened form of the varicella-zoster virus.

The vaccine is around 14 times more potent than the same vaccine virus in the existing varicella (chickenpox) vaccines recommended for children, as more virus is needed to stimulate T-cells in older people who are already infected.

The zoster vaccine, given as a single dose, has been registered in Australia and other countries for almost a decade, but with limited availability. It has been shown to be effective and safe from 50 years of age.

About half the people who are vaccinated develop pain, swelling or redness at the injection site, but this is usually mild and short-lived.

Importantly, because it is a live attenuated vaccine, it should not be used in people with significantly compromised immune systems.

How effective is the vaccine and for how long?

The Shingles Prevention Study (SPS) enrolled about 40,000 adults and found that Zostavax, compared to placebo, reduced the risk of shingles by about half (51 per cent) and PHN by about two-thirds (67 per cent) in persons aged 60 years or over.

But vaccine protection against shingles decreases with age: from 64 per cent in people aged 60-69 years, to 41per cent among 70- to 79-year-olds, and 18 per cent for those aged 80 years and over.

On the other hand, protection against PHN in those aged 70-79 years was the same as in people in their 60s; risk of PHN was reduced by about two-thirds in each group. This means that even if a vaccinated person in their 70s develops shingles, their chance of getting PHN should be reduced by about 50 per cent.

How long protection from a single dose of the vaccine lasts is still under study. Clinical trials showed protection waned over five years after vaccination; protection may extend longer, but this is uncertain.

At this stage, a second or “booster” dose is not routinely recommended.

Why is free vaccine only offered to people in their 70s?

With all of these considerations in mind, the choice of who to provide free vaccination entailed complex modelling that factored in both peak age of disease and severity, and loss of effect of the vaccine over time.

After considering these and other factors, vaccinating at 70 years of age – with a “catch up” program offering free vaccine to 71 to 79 year olds over the coming five years – is the most cost-effective strategy.

Outside of the funded program, zoster vaccine can also be prescribed for anyone aged 50 to 69 or over 80 years of age but recipients will have to pay.

More information on the vaccine is available at www.ncirs.edu.au.

Have you ever had shingles or know of someone who has? How did it affect you? Does a vaccine against the disease interest you?The Conversation


Kristine Macartney, Associate Professor, Discipline of Paediatrics and Child Health, University of Sydney and Sanjay Jayasinghe, Research Fellow at the National Centre for Immunisation Research and Surveillance; PhD candidate in Child and Adolescent Health, University of Sydney

This article was originally published on The Conversation. Read the original article.

The Conversation

The Conversation is an independent source of news and views, sourced from the academic and research community and delivered direct to the public. Their team of professional editors work with university, CSIRO and research institute experts to unlock their knowledge for use by the wider public. We republish The Conversation's content under Creative Commons License.

  1. Worst pain I have had just continues and never lets up

  2. Worst pain I have had just continues and never lets up

  3. My aunt contacted shingles at age ninety and 10 months on is still suffering!

  4. My mother had shingles in her late eighties, and she hasn’t been the same since. It took too long for it to be diagnosed and it was too late to get the initial medication to help ease it. The pain she had was unbearable and suffered terribly and is still suffering. If you are eligible I suggest you get the vaccination than risk going through what my mother went through.

  5. I had shingles last year it was the worst pain I have ever had and it lasted for months,I was only 64 and I think people in their 60’s should get free vaccine. Other wise it costs $200 which pensioner. Can,t afford.

    Pam

  6. My husband who has Parkinson’s disease had shingles a short while ago , should he have the vaccine?

  7. It affected my eye and right side of my scalp. Lucky to have my sight. Alert GP put me on “The” antiobiotic and referred me to an eye specialist immediately. Weeks of appointments but have retained the sight. Advanced the cataract and have had that done after infection had decreased. Very happy but have not regained my normal energy after 14 months. Pain incredible, very depressing .

  8. Although I had a mild case when I was quite young I got it again early this year. Never wont to go through it again. Ten months later even though I started a course of anti viral tablets within 24 hours I still get some after effects although quite mild now. Thus will have vaccine this week.

  9. Question:
    I had shingles this year. Unbearable pain for four weeks. Finally all clear.
    Do I still get the vaccine? I am 70.

    2 REPLY
    • I had shingles 20 months ago -was in hospital for 11 days – the pain all t
      his time on is sometimes just as bad where the rash was across my back and down one leg.! I am almost 80 years old – should I have the vaccine (I also have Lupus)

    • i believe you should. My doctor suggested I get it As was only 60 when I had shingles in the eye area.and have to pay a lot for the needle. Ask your doctor .

  10. I have had it three times in last ten years. Treated with Aciclovar, very effective. I am 69 and cant wait to be eligible for vaccine.

  11. Had it last year, worst pain i,ve had, i have a bad back injured doing aged care, wasn t sure if my back was bad but it turned out to be shingles, worst thing i,ve ever had, didn,t matter what i did or not, the pain was unbearable, worse than my worse migraine

    1 REPLY
    • I had Shingles about 12 years ago around my chest starting on the right side worked it’s way right around my back to my left side the pain was incredible. Now for the last 3yeara l have had agonising pain in right rib area . l have been to so many Doctors and so many tests done to find out all along it has been nerve damage from Shingles and l have been told l will have to learn to live with pian management and nerve pain medication ,nothing else works ! So YES !!!! if this can be avoided by an injection l would highly recommend it ( l know l will be trying to get onto it asap !_) l might have to wait as l an 62 years old

  12. Yep I had shingles when my twins were 8 months old (think my body finally said “enough”!)…not only the pain but the hot, insanely itchy rashes and superating sores….I had them down one side of my face and neck and the dr said keep the babies away…where do babies like to “nuzzle/snuggle” into their mother?!?! I’m not 70 but my husband is, will definitely get him inoculated! Whooping cough injections should be free too!

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