Shingles the disease

April 25, 2011

Shingles is a disease that is usually found in older adults. While the disease used to be found more often in those sixty and over, the number of people in their fifties with the disease is increasing.

Despite the fact that shingles is mostly found in older adults, understanding of the disease begins with an understanding of the common childhood disease known as chicken pox.

Chickenpox is a common disease that is frequently contracted by young children and which practically everyone has heard of and many have had it as a child.

Chicken pox is caused by a virus known as thevaricella zoster virus (abbreviated asVZV).

To defend and protect us against being overrun and killed by the numerous varieties of harmful or disease causing bacteria and viruses, our bodies have an immune system that exists to attack and fight off disease causing bacteria and viruses when they attempt to invade the body.

When the chicken pox causing varicella zoster virus enters the body, the immune system goes to work and begins creating antibodies designed to attack and fight off the virus.

In most cases, the body emerges victorious over the virus and, after about a week or so, the symptoms disappear and the patient is well again. In most cases, the patient emerges from a bout of chickenpox with no apparent lasting effects.

As a result of having had the disease, the person’s body now has a supply of antibodies ready to attack and repel any repeated attacks of the disease.

However, while the body is able to overcome the initial disease and prevent further attacks of the virus, it is not successful in completely destroying all of the varicella zoster virus in the body as a result of the initial attack. Instead, some of the virus survives and goes into hiding in the body waiting for another opportunity to attack the body.

The new attack, if it occurs, generally comes much later in life and takes the form of a slightly different disease known asHerpes zosteror, more commonlyshingles.

While closely related to theherpes simplex virusthevaricella zoster virusis not the same as theherpes simplex virusso that the way it acts and its symptoms are different from the socially transmitted disease (STD) commonly known as genital herpes which is caused by theherpes simplex virus.

Like chicken pox, shingles generally only occurs once in a person’s lifetime. However, there have been cases of people developing shingles more than once and this is a reasonable possibility given that shingles occurs in people whose immune system has been temporarily weakened.

For the average shingles victim, the sickness results in initial symptoms that include fever, chills, headaches and body aches. This first stage generally lasts from two to five days before the start of the second stage which consists of a rash and blistering with new blisters continuing to develop for up to five days or more. The rash and blisters are often accompanied by itching and sometimes pain.

While new blisters stop developing after about five days, the disease and symptoms can last anywhere from three to five weeks with the blisters first beginning to dry and become covered by scabs after which the scabs and rash finally begin disappearing. Once the disease has run its course it will usually leave behind a discoloration of the skin in the areas where the rash and blistering occurred although scarring rarely occurs.

In most cases shingles, like chicken pox, is not a nice thing to have but only lasts for a short time and when it is over there are no lasting negative effects. However, in a few cases both shingles and chicken pox can be accompanied by serious and long lasting complications.

In the case of shingles these complications generally take the form of postherpetic neuralgia(PHN) which results when the varicella zoster virus, which causes shingles, damages nerve fibers which are located below the skin.

The job of these nerve fibers is to messages from the skin to the brain. Damage to these nerve fibers can result in their sending false pain messages to the brain leaving the patient feeling pain from the affected areas for years or longer.

Only those who have previously had chicken pox can develop shingles. Since chicken pox is a common and very contagious childhood disease which about 90% to 95% of the population has had, the majority of the population is susceptible to shingles.

Unlike chickenpox, shingles itself is not contagious. A person cannot become infected with shingles as a result of coming in contact with another person who has shingles.

However, a person who has never had chicken pox can contract that disease from a person who has shingles. Then, after having had chicken pox, the the person who contracted chicken pox from the shingles patient, becomes susceptible to developing shingles.

Chickenpox and shingles have been around for ages, however as the symptoms of these two disease were similar to smallpox and other related diseases they were often confused with these diseases and often considered to be a type of smallpox.

The tenth century Persian physician Muhammad ibn Zakariya ar-Razi (865 - 925 A.D.) was the first to identify chickenpox as a separate disease from smallpox.

Nearly a millennium passed before the British scientist William Heberden in the late eighteenth century developed a way to distinguish shingles from smallpox. And it wasn’t until the beginning of the twentieth century that the connection between shingles and chickenpox was discovered.

While chicken pox is generally a mild, but uncomfortable, disease for most children, it can, in a few cases, become very serious and carry the possibility of serious and permanent ill effects. In adults, the disease is slightly more serious and poses a great danger to a fetus when a pregnant mother contracts the disease.

There is also an economic concern as chicken pox, being very contagious, can quickly spread through schools and day care centers.

In the 1970s a vaccine for chicken pox was developed in Japan and, after testing, began being used widely in Japan and Korea beginning in 1988 to immunize children in those two nations.

Since 1995 the chicken pox vaccine has become a standard immunization shot for infants in the United States. Adults and older children who have never had chicken pox as a young child are also candidates for the chicken pox immunization.

As for shingles, an immunization has also been developed in recent years. In 2006 the vaccine, Zostavax,was approved by the the FDA (Food and Drug Administration) to be given to patients in the United States approved.

However, Zostavax is costly to produce, deliver and stockpile with the result that it currently costs up to $300 per patient to administer. Mainly because of the cost, Zostavax is not approved for coverage under Medicare although some, patient paid, Medicare Part D prescription drug plans do provide coverage for Zostavax.

Using Medicare guidelines as their own guide for coverage, many insurance companies also do not cover the Zostavax vaccine for their customers.

Shingles is not a widespread disease. However, since the incidence of shingles increases with age we can probably expect to see it increase somewhat in years to come.

Since advances in modern medicine are resulting in increased life expectancy it is only natural that the number of shingles cases will increase as the number of people in the age ranges where shingles commonly occurs increases.

Because modern medicine has been able to immunize against or better treat many diseases that were deadly in the past more people with weaker immune systems are living longer and they could be more susceptible to shingles thereby increasing the number of cases.

Finally, some studies have indicated that exposure to chicken pox after having had the disease results in a boost to the immune system’s defenses against future shingles attacks. Parents, grandparents, doctors, etc. who are in contact with children with chicken pox seem to have lower rates of shingles outbreaks than those who are not exposed to children with chicken pox.

The development and use of thevaricella vaccine to immunize children (and adults) against chicken pox has reduced the number of cases of chicken pox which has the side effect of reducing the chances of coming in contact with someone with that disease.

Since some of the virus in the vaccine stored in the body just as it is with a case of the chicken pox, people with the varicella immunization are immune to chicken pox but do have the virus that can result in shingles later in life.

What is important to remember when measuring any events in a large population is not the total number of incidents but the rate per thousand or percent of the population affected.

With shingles we are generally talking about 1 to 3 cases per thousand people under 30 years of age with the number increasing as people get older. However, even as we approach ages 80 and above we are only talking about fourteen or fewer cases of shingles in that higher age group.

While the total number of cases may increase as the number of octogenarians in the population increase but the percent or number of cases per thousand of those eighty and above will remain the same.

Finally, there is the Zostavax vaccine to provide protection against shingles.