September 02, 2015

What you need to know about shingles

By Anna Sharratt

About one in three Canadians will get shingles but new treatments can lessen symptoms and there’s a vaccine that can help prevent it.

Last December was anything but festive at our house. In the last week of school before the holidays, my son brought home chicken pox. Worse, he gave it to my husband, who had somehow miraculously navigated childhood in the 70s without contracting the unpleasant illness.

Chaos ensued. For weeks, my husband, sporting thousands of itchy blisters, a fever, shortness of breath and fatigue, was in agony. At a follow-up visit after the worst was over, his doctor gave him more bad news: Now that he had had chicken pox, he was at risk of developing shingles, a painful rash caused by the same virus: herpes zoster. Let’s just say he’s now weighing getting the shingles vaccine.

Odds are good that he -- and many of the rest of us -- will get it. “About one in three Canadians will get shingles,” says Dr. Vivien Brown, a Toronto family doctor and board member of Immunize Canada. “By the time you are about 80, 50% of average Canadians will have had an episode,” she says.

Most at risk are women, people with a family history of shingles, diabetics, patients taking statin drugs and those with chronic obstructive pulmonary disorder.

Though young people can get shingles, “the greatest risk factor is age,” says Brown. “The older you are, the more likely you are to have shingles and to have a more severe case.”

Shingles symptoms and treatment

Shingles is no picnic. It can cause severe pain that’s often mistaken for a muscular condition, tingling, itching and then a painful rash that can occur anywhere on the body. Usually located together in one strip, the fluid-filled blisters that pop up resemble chicken pox blisters. Until the blisters dry up and scab over, you can infect someone with chicken pox – not shingles – if they haven’t yet had it. And, as with chicken pox, the blisters can scar.

The condition can be serious. “I have seen cases of post-herpetic neuralgia,” says Dr. Frank Martino, corporate chief of family medicine at William Osler Health System in Brampton, Ontario. Post-herpetic neuralgia is a condition in which your nerve fibers become inflamed, causing a burning pain. “The neuralgia can wax and wane, but it can go on for years.”

Martino says the cornea can also be affected, causing vision problems.

Plus, there’s a cardiovascular risk. “In the first few weeks after shingles, there is an increased risk of stroke,” says Brown. She says about 20 people die of shingles every year.

Treatment of shingles consists of trying to reduce the severity of symptoms. According to Martino, there is no topical ointment that works magic, save for the usual battery of calamine lotion, witch hazel and baking soda. Antihistamines can help with itching as well, as can pain medications, ranging from over-the-counter drugs such as acetaminophen and ibuprofen, to doctor-prescribed narcotics.

Once shingles has been diagnosed, your best bet is doctor-prescribed antiviral drugs, which can help reduce severity if taken within the first 72 hours, says Martino. Better yet is to try to prevent shingles in the first place with the shingles vaccine, says Brown.

Shingles vaccine

The Public Health Agency of Canada recommends people over 60 get the shingles vaccine, though those 50 and over can also receive it. It is given as one dose.

The vaccine doesn’t offer 100% protection, but it reduces your risk of developing shingles by about 55%, and of post-herpetic neuralgia by more than 75%, according to Brown.  As well, if you do develop shingles post-immunization, it’s usually a milder case, she says. The vaccine is not currently covered under provincial health plans, and costs approximately $200.

The shingles vaccine is not recommended if you:

  • have had a life-threatening, allergic reaction to any part of the vaccine, including gelatin or neomycin
  • have a weakened immune system
  • have active, untreated tuberculosis
  • are pregnant or breastfeeding
  • are currently sick with another illness

If you are considering the vaccine, talk to your doctor.

  • People who have never had chicken pox should get the varicella vaccine (to prevent chicken pox) – not the shingles vaccine. The varicella vaccine will not prevent shingles.
  • The chicken pox vaccine poses a slight risk of developing shingles later in life, according to the Centers for Disease Control. But the chances of that happening are less likely than getting shingles after natural infection with the herpes zoster virus.

Martino, for one, feels the vaccine is a good idea. He’s familiar with the secondary infections that can develop after shingles – serious infections of the skin that require antibiotics. “I think the vaccine is great.”

Brown agrees. She hopes that the 11.25 million Canadians over 50 who haven’t already had the shot get vaccinated.

“When we think about the cost of vaccine, let’s remember the cost of not being vaccinated,” she says.

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