Rash Decision

Getting vaccinated for shingles can ward off a lot of pain.

With good reason, and in time for the season, people are scrambling to get their flu shots. But there's another vaccination — against an ailment that inflicts maddening misery on at least 1 million individuals each year — that might prompt us to take another jab in the arm. It's the shingles vaccine, Zostavax, which was FDA-approved in 2006 and officially recommended last year by the Centers for Disease Control for people age 60 and older.

Although shingles strikes people of all ages, it's especially hard on seniors. As Dr. John Huber, of Memphis Dermatology Clinic, explains: "The older you are when you get shingles, the more severe the pain is, and the more likely you are to get post-shingles neuralgia, or inflammation of the nerve," he says. "Even after the blisters go away, the pain can persist for a long time."

Shingles is caused by the chickenpox — or herpes zoster — virus. It can stay in our nervous systems decades after the childhood disease runs its course. Then, for reasons not fully understood, it reactivates and we've got pain and itching like nobody's business.

"Usually shingles starts with a stabbing electrical-shock kind of pain," says Huber, who sees about 20 cases each year. "The patient will say, 'I think I've wrenched my back. It feels like a joybuzzer stuck there.'" Other patients may think an insect has bitten them, as little blisters start to form. "They're like dew drops on a rose," says Huber, "that soon coalesce into big ugly plaques."

Most cases of shingles last two to three weeks, and are treated for 7 to 10 days with an oral antiviral medication such as Valtrex. Early treatment and pain medication can help prevent post-shingles neuralgia. "The virus works like this," says Huber. "It's hanging out in the nerve root and travels down the nerve. Your immune system senses viral particles in the nerve and so it attacks. It keeps on hammering even after the virus has been killed, and that relentless attack causes neuralgia."

A painkiller, Huber continues, "will tell the immune system to ignore the nerve. Then all the white blood cells that were sniffing around the particles will cease and desist. With shingles, I don't worry about patients abusing painkillers, because this condition hurts. You need relief." In rare cases, the virus can result in blindness, brain inflammation, and death.

With the vaccine Zostavax, shingles and its ramifications can be prevented. Some primary care doctors administer the vaccine, which is also available at Walgreen's Take Care Clinics, and from The Shot Nurse. Though not totally effective, the vaccine does reduce the risk of shingles by half for adults over age 60, according to the CDC, and the risk of post-shingles neuralgia by 67 percent.

Many experts believe that stress can cause the chickenpox virus to kick into action after decades of lying dormant. "Stress can wear you out and weaken your immune system," says Huber, who suffered with shingles himself when he was 33. "I had a lot of issues — a growing family, medical school, my residency. I don't think I even realized how stressed I was," he adds.

Deborah Overall, director of The Shot Nurse, says the vaccine is recommended for those over age 60, "but [younger patients] can receive it if their doctor recommends it for certain circumstances, such as family history or medical conditions." The vaccination, at a charge of $205, is administered by appointment because "it's a frozen vaccine and must be kept on dry ice," says Overall. "It's a great vaccine and we get quite a few requests for it," she says, "especially from those who know others who have had shingles and want to avoid the pain."

For more information, go to Zostavax.com. M

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