| It is sometimes referred to as “chickenpox the second time
around.” Nearly one out of every five people reading this story will some
day be affected for a second time by the varicella-zoster virus —
the same virus that causes chickenpox in children. Only this time, the
symptoms may be worse and longer-lasting, a condition known as shingles.
NIH scientists are now involved in testing an experimental vaccine to
prevent this painful disease.
So, why the replay in later life? After you recover from chickenpox,
you are immune from ever getting that disease again. However, the virus
hides harmlessly in your body and can reemerge to cause shingles, triggered
by such things as an immune disorder or the use of drugs that lower
immunity (e.g., anti-cancer drugs).
Up to one million Americans are affected by shingles each year, according
to the National Institute of Allergy and Infectious Diseases (NIAID),
a component of the National Institutes of Health (NIH). Generally speaking,
older people are more susceptible to shingles because their immune system’s
memory of the varicella virus decreases with age. More than half of
all people affected are age 60 or older, though occasionally shingles
may strike a young adult.
In doing its damage, the virus typically travels down a nerve and
breaks out on the skin, leaving a rash or cluster of red dots that may
initially be very itchy, or you may have burning, tingling, or shooting
pain (early symptoms may also include fever or malaise — feeling
under the weather). Shortly, these red dots develop into painful, fluid-filled
blisters that normally appear only on one side of the body, or sometimes
on the face. In time these blisters become crusty. After the crustiness
disappears, you may be left with considerable, lingering pain where
the blisters have been (called post-herpetic neuralgia) and this can
last for months or even years. Additional problems may develop, including
sleep disturbances, anxiety, depression, ear or eye damage, and partial,
temporary facial paralysis. In a small percentage of cases, inflammation
of the brain (encephalitis) could occur. Symptoms normally last three
to five weeks, occasionally longer, and can be debilitating.
Testing a Shingles Vaccine
A five year clinical study of an experimental shingles vaccine is
now being conducted by the Department of Veterans Affairs in scientific
collaboration with NIAID scientists and Merck and Company, which developed
the vaccine. Researchers are recruiting generally healthy subjects,
age 60 and older, with no prior history of shingles. To date, about
1,000 men and women have already participated at the NIH’s Clinical
Center in Bethesda, Maryland.
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Shingles: What Helps?
Several treatments can help shorten the length of time you have shingles
and/or curb the discomfort, according to Dr. Mitchell Max, a neurologist
and pain specialist with the National Institute of Dental and Craniofacial
Research (NIDCR), a component of the NIH. But treatment must be started
early to be effective. Topical ointments, cool compresses, or even calamine
lotion may provide some symptomatic relief.
If these are not enough, however, there are several things your doctor
can prescribe for you:
- Acyclovir or other antiviral drugs to combat the virus.
- Opiate drugs to counter the pain.
- Steroid drugs such as prednisone to reduce skin inflammation.
- A topical anesthetic patch to reduce the pain.
- Antidepressants to reduce the chronic pain that may develop.
- In cases of extreme, non-relenting discomfort, a nerve block to
provide relief for days or even weeks.
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