Lifelong Health by Dr. David Lipschitz

After age 60, everyone should receive the shingles vaccine.

Shingles is a painful and debilitating illness that impairs quality of life. It is caused by the herpes zoster virus related to chickenpox. Despite the fact that vaccination against shingles is highly effective in preventing the disease, new information published in the journal PLoS Medicine suggests that fewer than 4 percent of Medicare recipients have received the vaccine. Of more than 766,330 individuals surveyed from January 2007 to December 2009, only 29,785 (3.9 percent) were vaccinated. During this time, 12,958 cases of shingles occurred in the unvaccinated (1.7 percent), compared with 154 cases among those who received the vaccine (.5 percent).

Most who develop shingles have had chickenpox as a child. The chickenpox rash usually starts in the upper body, arms and legs. Beginning with a mild fever, it takes about two days for a rash that blisters and eventually forms a scab. Chickenpox is more serious in adults, particularly in adult cigarette smokers, individuals with lung disease and in pregnancy, when premature labor and life-threatening infection in the fetus can occur.

After you have chickenpox, immunity against further infection develops. However, the virus persists indefinitely in the body, lying dormant in nerve cells. After the age of 60, for reasons that are ill understood, the virus starts growing in the nerve, and shingles develops in the area of the body where the particular nerve functions.

The disease is always on one side of the body, and it can occur anywhere.

Sometimes the area affected is small; other times it is large. The earliest symptom is severe itching followed by a blotchy, painful rash. Within a day, the rash becomes violently red and painful. As with chickenpox, blisters burst, leading to bloody scabs. The pain and itching can be intense and the urge to scratch makes things much worse.

Shingles is particularly dangerous if it involves nerves around the face. The eye and ear can be involved, leading to blindness or deafness.

It is very rare for shingles to spread from one person to another. This only occurs in someone who has either never had chickenpox or been vaccinated against chickenpox or in individuals with severe illnesses that impair immune function and the body's defense mechanisms.

A person with shingles should never visit hospitals or centers where patients with cancer are being treated. In these patients, the virus can spread throughout the body, an illness that often proves fatal.

Antiviral treatments are available to stop proliferation of the shingles virus. The earlier treatment is commenced, the milder the infection, making complications less likely. Anyone who develops a painful, itchy rash localized to only one area of the body should see a physician as soon as possible. Treatment lasts for 10 days. Most people recover completely.

The most serious adverse effect of shingles is long-term irritation of the nerves in which the infection occurred. Called post-herpetic neuralgia, it presents with severe pain, burning and itching. Usually the symptoms last less than a year, but in some they can exist for much longer. Medications that "soothe the nerves" are often beneficial. These include certain antidepressants and drugs initially developed to treat seizures. On occasion the pain is so severe that narcotic therapy is needed.

The shingles vaccine reduces the risk of the illness by more than 70 percent. It is particularly important that people who had chickenpox as a child get vaccinated because their risk of shingles is much higher. Research published in the Journal of the American Medical Association has determined that the vaccine, despite being a live virus, can, in most circumstances, be given safely to those with declines in immune function from either an illness or therapy to treat diseases such as rheumatoid arthritis, lupus or inflammatory bowel disease.

Many experts recommend that the vaccine be given to those who have had shingles. This remains controversial, as research published in the Journal of Infectious Disease showed that shingles recurrence in patients who have had the disease was identical in those who subsequently did or did not receive the vaccine.

As those who have suffered this disease all attest, better to be safe than sorry. See your doctor and, unless there is a compelling reason not to, have the shingles vaccination as soon as you reach that magical age of 60.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at: www.drdavidhealth.com

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