Last night I saw a TV ad for an immunization, sold by Merck, that folks over 60 can take to reduce the odds of developing Shingles (http://vimeo.com/39234180 and Span, 2012). I had not heard Shingles mentioned since my aunt developed it back in the 1970’s. The ad said that 1 in 3 persons might develop Shingles and that the odds increase as we age. Welcome to the “Golden Years.”
Since I had not come across Shingles as a topic of conversation, let alone actual consideration, in almost forever, I wondered about the accuracy of those odds and did a little checking.
However, before proceeding here is a quick primer on Shingles, the disease.
“After you have chickenpox, the virus that caused it, called varicella, [or the vaccination taken to prevent it] remains in your body. It’s always inside you, lying dormant in your nerve cells. At some point later in life, your immune system may weaken, allowing the virus to resurface as Shingles… There is no cure for Shingles. The Shingles rash usually lasts up to 30 days… Shingles can sometimes lead to serious complications. About 1 in 5 people [who demonstrate the disease] end up with postherpetic neuralgia, or PHN. This is long-term nerve pain that may develop after the Shingles rash heals, and it can last for months, or even years.” (http://shinglesinfo.com). Finally, topical steroids and oral antihistamines can help reduce the itching and there are antiviral medications that may help if administered within 72 hours of onset of symptoms.
Since like 99.5% of us who are currently over 40 have had chicken pox or were vaccinated for it, shingles is hovering in wait for our immune systems to change due some random event. A couple of studies give insight to the incidence rate. Yawn (2007) found an adjusted rate of 3.6 per 1000 person-years in a sample of adults with higher rates among people older than 50 years. The CDC says that, “The incidence among people 60 years of age and older is about 10 cases per 1,000 U.S. population annually. Brett (2007) interprets these sorts of findings to mean that a 70 year old person has about a 10% chance of developing Shingles over the next decade.
The recently approved vaccine for the prevention of reactivation of varicella-zoster virus (VZV) appears to reduce “the incidence of shingles by 51 percent and the incidence of PHN by 66 percent…” (NFID) A recent clinical trial (Schmader, 2012), showed reduction of almost 70%. All is not totally rosy as Arroyo (2012) raises the specter of introducing yet another virus to ones system that may activate in some clever new fashion down the way. However, if this new expression takes 30 or 40 years to activate, one need not be too concerned unless life expectancy increase rapidly as well.
References
- Arroyo, JC. Unsettled Issues of Zostavax Vaccine. Clin Infect Dis., 2012, 55, 6, 889-890. First published online June 13, 2012. http://cid.oxfordjournals.org/content/55/6/889.1.short#
- Brett, AS. What Is the Incidence of Shingles? Published in Journal Watch General Medicine, November 15, 2007. http://general-medicine.jwatch.org/cgi/content/full/2007/1115/1
- Centers for Disease Control and Prevention (CDC). Shingles (Herpes Zoster) Clinical Overview. http://www.cdc.gov/shingles/hcp/clinical-overview.html
- National Foundation for Infectious Diseases (NFID). Shingles Information for Health professionals. http://www.nfid.org/idinfo/shingles/Information-for-Health-Professionals
- Oxman MN et al for the Shingles Prevention Study Group. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med, 2005, 352, 2271-2284.
- Schmader, KE et al. Efficacy, safety, and tolerability of Herpes Zoster Vaccine in persons aged 50–59 years. Clin Infect Dis., 2012, 54, 7, 922-928.
- Span, P. The Shingles Vaccine Returns. The New York Times, 5-15-2012. http://newoldage.blogs.nytimes.com/2012/05/15/the-shingles-vaccine-returns
- US Food and Drug Administration. Zostavax™ questions and answers. Available at http://www.fda.gov/BiologicsBloodVaccines/Vaccines/QuestionsaboutVaccines/UCM070418.
Image Source
Detail from a photo at shinglesinfo.com. http://www.shinglesinfo.com/shinglesinfo/shingles-in-depth/shingles-pictures.jsp?WT.mc_id=ZX09M&WT.srch=1
Rodger Marion 
November 28, 2012 at 9:04 am
Transcript – Weekly Discussion on Aging 11-27-12
[06:31] Elle Bellah is online.
[06:32] Rodger Markova: Hi Ellen
[06:32] Rodger Markova: How are you?
[06:32] Elle Bellah: Hi Rodger, I’m good
[06:40] Elle Bellah: Funny you chose the shingles thing, I see so many people, well two in my office getting them. Is it something that is more likely to get with age?
[06:41] Rodger Markova: Yes. The odds go up as you get older. It’s an immune system thing and our immune systems change as we get older.
[06:41] Elle Bellah: We have a 40 year old woman who has been out for 6 months due to shingles.
[06:42] Rodger Markova: Oh my. That’s a serious case
[06:42] Elle Bellah: I guess I think of things breaking down as we age but not immune system and the results.
[06:42] Rodger Markova: Most people get a rash and it hurts and goes away in a month or so.
[06:43] Elle Bellah: Yes that is what I have understood.
[06:44] Rodger Markova: I found it curious to consider that if you are immunized as a kid for Chicken Pox, it puts the virus into your system and can reappear as Shingles 50 years later.
[06:44] Elle Bellah: Yes when I read that it made me feel like a time bomb.
[06:45] Rodger Markova: The long term consequences of a health benefit are hard to predict. Something to think about when any new drug or treatment is introduced.
[06:46] Elle Bellah: Yes
[06:46] Elle Bellah: Well, I am going to log off, have some things to do at my desk, but will attend next – ok bye
[06:47] Rodger Markova: Bye Ellen
[06:47] Elle Bellah is offline.