The Changing Face of Shingles

For some individuals it appears as a mysterious itchy red rash; for others, fever is followed by soreness, which develops into painful blisters. Once thought of as a syndrome affecting only the elderly, herpes zoster, commonly known as shingles, is affecting more young adults.

Puzzled by its occurrence in the youth population, doctors and researchers are attempting to demystify shingles, a poorly understood but serious illness.

What is it?

In the early 1900s doctors confirmed that the same varicella zoster virus that causes chicken pox was also found in the fluid of shingles’ blisters. In 1953 Nobel Laureate Thomas Huckle Weller determined that a new infection of the virus was not responsible for shingles.

Rather shingles were caused by a reactivation of the original varicella virus that caused chicken pox. It can stay dormant for decades in a person’s nerve roots and present as a painful, blistery rash years later.

Its name is derived from the Greek word cingulum meaning a belt or a girdle, since the characteristic rash typically appears as a band around the chest or back. 

Why does it develop?

What changes varicella from dormant to actively reproducing in nerve cells and presenting as the characteristic painful rash? Although not well understood, many scientists agree that low immune protection plays a role in acquiring shingles. Once a person becomes 50 years of age, the immune system’s vigilance is not as optimum, allowing for the reproduction of the once-dormant virus.

However, shingles is now appearing in individuals in their late teens and early twenties, which has caught the interest of researchers trying to figure out why the disease has chosen to strike a younger population.

Is the chicken pox vaccine to blame?

After years of experimental trials, the varicella vaccine was licensed by Health Canada in 1998. Some researchers believe this changed the pattern of the disease. Children who do not receive the varicella or chicken pox vaccine have a 90 percent chance of being infected with varicella by age 12.

Post-vaccine, cases of chicken pox have been drastically reduced. Strangely enough, this drastic decline in varicella, according to researchers, may actually lead to an increase in the rate of shingles among the unfortunate group of young adults who had chicken pox just prior to the universal varicella vaccine program.

Individuals who are repeatedly exposed to the virus are less likely to develop shingles. So those who did contract chicken pox as a child but missed the varicella vaccine rollout were not exposed to active infection by their immunized younger peers. They are likely experiencing a higher incidence of shingles in their twenties and thirties due to low exposure to the virus.

Researchers at the National Public Health Service Communicable Disease Centre in the UK question why the vaccine was introduced in the first place since evidence suggests that chicken pox rates were decreasing even in areas where varicella vaccination was not yet universal.

A possible explanation for this decline may be attributed to more social mixing of children at younger ages in daycares where they become mildly exposed to the virus starting at an early age.

Symptoms

Although it’s difficult to predict the extent to which younger people are going to encounter shingles, the good news is that when younger people get shingles, the complications are less serious than for older individuals. The typical fever and blistery rash subside with time; however, the symptoms may require pain relief.

Consult your health care practitioner if you have a painful rash with blisters. Severe pain may be experienced even before the rash appears.

Complications

One of the most common, and painful, complications of shingles is postherpetic neuralgia (PHN). The varicella virus irritates the nerves of sensation, creating what can be severe and debilitating pain. PHN occurs in 10 to 15 percent of shingles sufferers, mainly in people over the age of 50. Again, consult your health care practitioner.

Susceptibility

Shingles is believed to be linked by family history. A study by the University of Texas Medical School found that 39 percent of individuals who had contracted shingles also had a family member who had the disease, compared to 11 percent of subjects who never had shingles and were unaware of a family member with shingles.

Interestingly, contact with someone with an active chicken pox virus may actually reduce the risk of developing shingles. British scientists looked at data from 244 patients and found that contact with children who had an active chicken pox infection seemed to help reduce the onset of shingles in latently protected adults who previously had chicken pox.

One idea put forth to improve the outcome of the vaccine is to offer a booster dose so that the immune system is better primed for defence. Some question the necessity of vaccinating a very common and mild illness. Perhaps with less exposure to the virus, a disadvantage is being placed on our children as we overvaccinate and in turn overprotect them.