About 1 in 3 Americans will develop shingles, which translates to 1 million cases annually
Pain may begin 2 to 4 days before the rash appears, and severe pain may persist as post-herpetic neuralgia (PHN).4,5 Patients with PHN report burning, shooting, stabbing, and/or throbbing pain. Other symptoms include chills, loss of or decreased hearing or vision, fever, gastrointestinal upset, headache, muscle weakness, scarring, or skin infection. Herpes zoster ophthalmicus (HZO) is a growing problem. An analysis of 21 million adults showed that HZO tripled from 9.4 cases per 100,000 people to 30.1 cases per 100,000 people over a 12-year period.
HZO can lead to blindness and scarring on the cornea
WHO IS AT RISK?
Shingles is uncommon, but it is not unknown in children. The risk increases with age, especially after age 40. Individuals age 60 or older are 10 times more likely to develop shingles than a 10-year-old. adults at greatest risk
Although VZV causes both chickenpox and shingles, they are different. Chickenpox is a mild disease that primarily affects children and then remains dormant in the body’s central nervous system.1,4 Shingles results from viral reactivation when a trigger weakens the immune system. Researchers suggest different triggers (BOX1,4).
About half of all shingles cases occur in individuals over the age of 60 and half in younger individuals, although shingles appears to be on the rise in the latter group.5
Here too, the immune compromise increases the risk
Shingles don’t come back in most people, but it can come back a second and rarely a third time.9 After an outbreak, the chance of recurrence is initially lower than the chance of a first outbreak in shingles-naive people. However, within 7 years, the recurrence risk approaches 5%, which is comparable to the risk of first-time shingles. In addition to immunocompromised individuals, patients who have had persistent pain associated with shingles for more than 30 days and women are at the highest risk of recurrence. Recurrences usually affect another part of the body
A cancer diagnosis of any kind in any age group has been associated with a 40% increase in the risk of developing shingles.10 Patients with hematologic cancer have been associated with a three-fold higher risk, and the risk appears to be 2 years earlier to be present. to the diagnosis.
Firm tumors also increase the risk (but slightly less than hematologic cancer) and often while the patient is receiving chemotherapy, which is immunosuppressive.10
Individuals with active shingles can pass the virus on to others who have never had chickenpox or who have not been vaccinated.11 If blisters are present, direct contact with fluid from blisters can spread VZV. The CDC recommends not scratching or touching the rash, covering the rash, and washing hands often.
It also recommends avoiding contact with individuals with immunocompromised immune systems, low birth weight or premature babies, and pregnant women who have never had the chickenpox or varicella vaccine.11
Vaccinating children with the chickenpox vaccine and adults 60 years of age and older with the recombinant zoster vaccine (RSV; Shingrix) is the best prevention. Children who receive the varicella vaccine are significantly less likely to develop pediatric shingles,11 and RSV reduces the risk of developing shingles by approximately 50% and significantly reduces the risk of serious complications.5
Antiviral drugs, such as acyclovir, famciclovir, or valacyclovir, reduce the duration and severity of a shingles outbreak if started within the first 3 days. Doctors may also prescribe duloxetine or nortriptyline, 8% capsaicin (Qutenza) skin patches for the affected areas, lidocaine patches to the skin, gabapentin or pregabalin, or opioids.9
Keeping the rash clean and dry will reduce the risk of infection. Patients should avoid antibiotic adhesives or topical dressings, use products such as calamine lotion to relieve and soothe itching, and wear comfortable, loose-fitting clothing.1
To better understand shingles, researchers are conducting studies, but need healthy individuals and those with shingles to volunteer. While we wait for better preventive methods and treatments, educating patients with facts about shingles can help them protect themselves from the condition and its complications.
ABOUT THE AUTHOR
Jeannette Y. Wick, MBA, RPh, FASCP, is the assistant director of the Office of Pharmacy Professional Development at the University of Connecticut School of Pharmacy in Storrs.
1. Cohen EJ, Jeng BH. Herpes zoster: a brief final review. Cornea. 2021;40(8):943-949. doi:10.1097/ICO.0000000000002754
2. Bianchi J. What it really feels like to have shingles. Prevention. February 24, 2016. Accessed June 15, 2021. https://www.prevention.com/health/a20500587/what-it-feels-like-to-have-shingles
3. Weinmann S, Naleway AL, Koppolu P, et al. Incidence of herpes zoster in children: 2003-2014. Pediatrics. 2019;144(1):e20182917. doi:10.1542/peds.2018-2917
4. Shingles Myths and Facts for Consumers. National Foundation for Infectious Diseases. Accessed June 15, 2021. https://www.nfid.org/idinfo/shingles/consumers-myths.html
5. Newman AM, Jhaveri R. Myths and misconceptions: exposure to varicella zoster virus, infection risks, complications and treatments. Clin Ther. 2019;41(9):1816-1822. doi:10.1016/j.clinthera.2019.06.009
6. Kirkendoll SA. Aging baby boomers are causing a skyrocketing incidence of shingles of the eye. Michigan Health Lab blog. May 1, 2019. Accessed June 15, 2021. https://labblog.uofmhealth.org/lab-report/aging-baby-boomers-push-sky-high-incidence-ofshingles-of-eye
7. Shingles: Hope through research. National Institute of Neurological Disorders and Stroke. Updated March 23, 2020. Accessed June 15, 2021. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Shingles-Hope-Through-Research
8. Shingles (herpes zoster). CDC. Updated August 14, 2019. Accessed June 15, 2021. https://www.cdc.gov/shingles/surveillance.html
9. Yawn BP, Wollan PC, Kurland MJ, St Sauver JL, Saddier P. Herpes zoster recurrences more frequent than previously reported. Mayo Clin Proc. 2011;86(2):88-93. doi:10.4065/mcp.2010.0618
10. Qian J, Heywood AE, Karki S, et al. Risk of herpes zoster before and after cancer diagnosis and treatment: a population-based prospective cohort study. J Infect Dis. 2019;220(1):3-11. doi:10.1093/infdis/jiy625
11. Shingles vaccination. CDC. Updated January 25, 2018. Accessed June 15, 2021. https://www.cdc.gov/vaccines/vpd/shingles/public/index.html