Although shingles can occur at any age, it most commonly affects people beyond midlife. The virus that causes shingles (varicella-zoster) causes chickenpox during childhood and then remains hidden in the nerve tracts. Under certain conditions it can be reactivated – shingles occurs. Shingles, which experts refer to as herpes zoster, is an acute infection confined to specific regions and accompanied by highly infectious blisters and pain.
From chickenpox to shingles
Initial infection with the varicella zoster virus usually occurs in childhood and manifests as intensely itchy chickenpox. Because the viruses are highly infectious, the rate of infection is also very high: after the age of eleven, 94 percent of the population has experienced this infection. However, chickenpox does not disappear completely from the body after the disease has been overcome. Some remain – “dormant” so to speak and kept in check by the immune system – in the ganglion cells of the nerve tracts for life. Under certain conditions, the viruses can be reactivated and lead to unpleasant shingles. Depending on which nerve tracts are affected, the zoster infection extends halfway around the body in a belt-like pattern from the spine, hence the name shingles.
Shingles: causes
The causes of viral reactivation are usually unknown, but it seems that with age or, for example, severe stress, the immune status is lowered – the virus can then travel back along the nerve pathways into the skin and trigger shingles. A weakened immune system due to illness and intense UV radiation can also promote the development of shingles.
Typical symptoms of shingles
The infection first becomes noticeable as burning, itching or stabbing pain. The typical rash as one of the symptoms appears later – about 1 to 3 days after the virus reaches the skin. This rash consists of red spots on the skin and small vesicles containing a virus-laden, infectious fluid. The acute phase of illness in shingles may also include the following symptoms:
- General fatigue
- Headache
- Fever
After another 3 to 5 days, the blisters break open and gradually form crusts, which fall off after 2 to 3 weeks. In most cases, shingles heals again without consequences.
Shingles: start treatment early
Early treatment of shingles is important to stop the viruses as early as possible and prevent further damage to the nerves – known as postzoster neuralgia. If early treatment is missed in people over 50 years of age and in cases of infestation in the head or neck area, this can lead to chronic pain lasting for months. Therefore, if you suspect shingles, you should see a doctor immediately for treatment. Immediately initiated acute treatment consists of two pillars:
- First, from the medication with antiviral drugs.
- On the other hand, from the consistent treatment of the pain caused by shingles.
Rapid viral inhibition is the basis for avoiding complications of shingles. Rapid relief of pain in the first few days can prevent postzosteric neuralgia resulting from shingles.
Shingles: postzosteric neuralgia (PZN).
Older people in particular may continue to feel pain in the areas affected by shingles for months or even years, which can be difficult to treat and can become chronic. This is no longer called shingles, but postzosteric neuralgia (PZN). Once the pain has become chronic, it is often difficult to control. The risk of this complication as a result of shingles increases with age. According to a rule of thumb, age roughly corresponds to the percentage risk. In the worst case, postzosteric neuralgia (PZN) can even persist for life and is sometimes unbearable for those affected.
Is shingles contagious?
Shingles is contagious only for people who have not had chickenpox. Direct contact with the secretion of the vesicles may result in an outbreak of chickenpox. However, vaccination against chickenpox as a child does not protect against contracting it when you are older and subsequently getting shingles.
Vaccination against shingles
A vaccine against herpes zoster has been licensed in Germany since 2013. The live vaccine is available under the trade name Zostavax for people aged 50 and older. The vaccine reduces the likelihood of shingles infection and lowers the risk of severe courses of the disease, although the protective effect decreases with increasing age. Another vaccine, approved since 2018 for people 50 and older, goes by the trade name Shingrix and is a so-called recombinant dead vaccine based on an antigen of the varicella zoster virus, among others. It is also considered effective in older people, although side effects such as swelling, itching, muscle pain, headache, fever or fatigue are more common after vaccination, but subside within one to three days.
Who should get vaccinated against herpes zoster?
According to the Standing Committee on Vaccination (STIKO), double vaccination against herpes zoster with an inactivated vaccine is recommended for
- Persons from an age of 60 years
- People from the age of 50 years, whose immune system is weakened.
- Persons aged 50 years and older who have a severe underlying disease (for example, rheumatoid arthritis, chronic diseases of the intestines, lungs or kidneys, or systemic lupus erythematosus).
The two vaccinations should be given two to six months apart. If you are interested in a vaccination against shingles, please discuss with your doctor whether such a vaccination is an option for you. The cost of shingles vaccination is covered by public health insurance for the above-mentioned groups of people.
