Tuesday, October 29, 2013
Preventing Shingles Through Vaccination
Blog contributed by Jamie Weeder, CRNP
Most of us have seen the commercials, the ones with the painful, blistering rash that burns like fire. Through personal experience, I can vouch that shingles is a horrible experience that is unlike any pain that I have ever experienced. I wanted to share my experience with individuals and use it to teach about shingles and the recommendations for vaccination.
What is shingles?
Shingles, also known as herpes zoster, is a painful rash that develops on one side of your face or body. Shingles is caused by the same virus that causes chicken pox, the varicella zoster virus. After a person has chickenpox, the virus becomes inactive (dormant) along a nerve route inside their body. The virus becomes reactivated many years later due to a decreased immune system caused by illness, medications, or stress.
Everyone that has had chickenpox is at risk for developing shingles. According to the Centers for Disease Control and Prevention (CDC), nearly 1 out of every 3 people in the United States will develop shingles. The risk for shingles increases with age and approximately 50% of shingles cases occur in people age 60 and older.
What are the signs and symptoms of shingles?
This past August on a Friday afternoon, I developed a painful aching along the right side of my jaw. I didn't think anything of the pain at the time, but the next day I realized something was wrong. The pain was getting worse and I had a red sore inside the right side of my mouth where the pain was coming from. I started to feel feverish and sick to my stomach. The pain was becoming more intense and felt like it was shooting from my jaw and into my right ear. I would like to believe that I have a good pain tolerance, but I must admit that the pain brought tears to my eyes and I would spend the next few days with an ice pack on my face to numb the pain.
Symptoms of shingles include a painful, itchy, blistering rash that presents as a band or stripe on one side of the face or body. The symptoms of pain and itching can occur between 1 and 5 days before the rash develops. In addition to the rash, people can develop fevers, chills, headaches, and nausea.
Due to my symptoms and developing more red spots inside my mouth that traveled along a line, I was started on antivirals and medication to help control the pain. A few days later the pain began to subside. Because of my age and the odd location of my rash (most rashes occur on the skin), blood work was done that confirmed that I had shingles. I remained on medication for approximately 3 weeks until the pain and rash completely resolved.
Shingles usually clears up within 2 to 4 weeks, but early treatment can help control the symptoms and resolve the disease faster. If you believe that you have shingles, contact your healthcare professional immediately as starting antivirals within 48 to 72 hours of developing the symptoms can shorten the length and severity of shingles. Early treatment can also help prevent chronic complications, such as postherpetic neuralgia which is severe pain along the rash that can last for months after the shingles rash resolves. The risk for postherpetic neuralgia increase in people over the age of 60 that are not treated for shingles.
Although rare, more serious complications of shingles include: pneumonia, hearing loss, vision loss, brain inflammation, or death depending on the severity and location where the virus activates.
How do you prevent shingles?
The only way to reduce the risk of getting shingles and postherpetic neuralgia is by getting vaccinated. Zostavax is the vaccine for shingles that the CDC recommends for individuals aged 60 and older regardless of whether they remember getting chickenpox.
Studies have shown that the risk of developing shingles after vaccination decreased by 50% and those who developed shingles had decreased severity and duration of symptoms. The U.S. Food and Drug Administration (FDA) has stated that the shingles vaccine was also effective in individuals between ages 50 and 59. If you are between the age of 50 and 59 and are interested in getting the shingles vaccine, you should speak with your healthcare professional. At this time, the shingles vaccine is not suggested for people younger than age 50 because more studies need to be completed.
Most individuals that have shingles will not develop the rash a second time, although it is possible to get shingles multiple times. Individuals that have had shingles can still get the shingles vaccine.
What are the side effects to the shingles vaccine?
The most common side effects of the Zostavax vaccine include headache and injection-site reactions. The vaccine in injected under the skin, usually on the upper arm. Possible injection-site reactions include redness, soreness, swelling, and itching. Some people may develop a chickenpox-like rash at the injection-site.
People that are allergic to neomycin should not receive the vaccine. The shingles vaccine is a live virus and should not be given to people with a weakened immune system such as those with HIV/AIDS, people taking medications to weaken their immune system such as steroids, and people receiving treatment for cancer. The shingles vaccine should not be given to women who are pregnant or may be pregnant.
It is safe to be around infants, pregnant women, and people with a weakened immune system after receiving the shingles vaccine.
How much does the shingles vaccine cost?
The cost of the shingles vaccine varies depending on your health insurance. While all Medicare Part D plans cover the vaccine, the amount that each individual pays varies. Medicare Part B does not cover the vaccine and Medicaid coverage varies. Most private health insurance plans cover the vaccine for individuals aged 60 years and older. Some private insurance plans provide coverage for individuals aged 50 to 59. For individuals that cannot afford the shingles vaccine, there are assistance programs available to make the vaccine more affordable.
Making Your Decision
As healthcare professionals, we want to provide you with education and your options for disease prevention and treatment. Deciding to get vaccinated is a personal decision that you should discuss with your healthcare provider. Due to my experience, I plan to get vaccinated when I reach the recommended age. If you have additional questions, speak with your healthcare provider or leave a comment below.