Herpes Zoster is an infection that affects about 1 million people in the U.S. each year. It is caused by the reactivation of the Varicella virus which causes chickenpox. Once chickenpox has resolved, this virus remains dormant in several nerve roots of the nervous system. But when it emerges…look out! An extremely painful bumpy rash appears along the distribution of 1 or more dermatomes (an area on the skin supplied by nerves from a spinal nerve root). The rash is known as “shingles”. The most common complication of shingles is postherpetic neuropathy (PHN) which is a painfully debilitating and difficult condition to treat. Even when the rash goes away, the pain can persist for 30 days to 6 months or longer.
Age is the #1 risk factor for developing herpes. About half of all cases occur in people 50 years of age or older. Other risk factors include a compromised immune system such as people with cancer or HIV infection, as well as those taking immunosuppressive drugs. Psychological or physical stress or trauma have also been shown to play a role in reactivating this virus.
One important way to reduce the incidence of herpes zoster is to get the chickenpox vaccine as a child. I know the topic of vaccines is quite controversial but I feel parents need to know the protective effects of the chickenpox vaccine, known as Varivax. Not only can this vaccine prevent a chickenpox outbreak, but it reduces the incidence of herpes zoster significantly later in life. A study in California from 2000-2006 showed the incidence of herpes zoster decreased by 55% in children 10 years or younger who were vaccinated against chicken pox (varicella).
Another way to protect yourself is with the Herpes Zoster vaccine known as “Zostavax”. This is a live, weakened vaccine recommended for most people 60 years of age or older. It is a more concentrated formulation of the varicella vaccine which was approved by the FDA in 2006. This one time vaccine was thought to be effective for a lifetime. Now we are finding that the effectiveness starts to wane as early as 4 years. The vaccine reduces the incidence of herpes zoster by 51.3% while reducing the incidence of PHN by 67%.
An ongoing study called the Shingles Prevention Study looked at over 30,000 participants 60 and older to determine how long the Zostavax vaccine was effective. Researchers showed that the vaccine effectiveness in terms of incidence of herpes zoster went from 51% to 40% from year 4 to year 5 after vaccination. The incidence of PHN went from 67% to 60%. Overall estimates of vaccine efficacy between 5 and 12 years after vaccination were 21% against contracting herpes zoster and 35% against PHN incidence.
We need to re-define the term-life long since it is clear that our aging population will continue to grow. The fastest growing age group in the U.S is age 85!! When many of these vaccines were formulated life-long meant something different (around 65-70 years old).
While most cases of shingles resolve spontaneously, complications can occur that effect quality of life and may even be life threatening and permanent (ophthalmic (eye) infections or Ramsey Hunt Syndrome). Treatment can shorten the length of illness and prevent complications. We use anti-viral and anti-inflammatory herbs as well as high dose Vitamin C I.V’s at our clinic. Prescription anti-virals such as Acyclovir or Valtrex can also be used. Talk to your health care practitioner about the Zostavax vaccine. We may be recommending a booster in the future, and there is also a new vaccine in the works that holds promise in being 97% effective!
References: Jacobsen, E et al. Herpes Zoster infection. Clinician Reviews, August 2013, pp. 42-49.
Zuger, A. Zoster Vaccine Efficacy: How Long? JWatch.org April 1, 2015, p. 57.