How to save your own skin
Doctors encourage baby boomers to get shingles vaccine
Cathy Abraham feels lucky.
The 55-year-old Waltham resident, a librarian by trade, said her doctors told her she would have gone blind in her left eye had an emergency room physician not correctly identified an odd rash on her left temple two years ago as shingles. Unbeknownst to Abraham, the encroaching virus had already entered her left eye.
She was immediately sent to an ophthalmologist and started on medications, yet the virus was so virulent, the dosages had to be increased. Two years after her shingles ordeal, Abraham still has blurred vision in that eye and must take daily steroid eye drops and antiviral medication, medicines that doctors have told her she may need for the rest of her life.
“I always thought shingles only affected older people in their 60s and 70s,’’ Abraham said. “I thought maybe I had an allergic reaction to something.’’
Shingles, a painful and sometimes debilitating infection and rash triggered by the same virus that causes chickenpox, can strike anyone who has had chickenpox. Treatment for shingles is antiviral medication to shorten the length and severity of the outbreak, but it must be given within 72 hours of when the rash first appears to be effective, specialists say.
Typically the illness hits people after age 50, and it becomes increasingly more common with age. As waves of baby boomers enter their 60s — the leading edge turns 65 this year — doctors are encouraging them to get a shingles vaccine, which has been available since 2006 and approved for patients 60 and older.
A study published last week in the Journal of the American Medical Association found that the vaccine was associated with a 55 percent reduction in incidence of shingles among the roughly 300,000 adults age 60 and older whose medical records were reviewed. That translated to one episode of shingles being averted for every 71 individuals who received the vaccine, the researchers said.
Yet repeated nationwide shortages of the vaccine, coupled with cumbersome freezer storage requirements for physicians, and an expensive price tag — roughly $200 — for patients whose Medicare plans or private insurance don’t cover the shot has meant few adults have received it.
Among those who have been trying to get vaccinated is Colman Herman, a 67-year old Dorchester resident and former pharmacist whose doctor recommended the shot last spring. He called to schedule an appointment and was told it was back ordered, and to call back in November. He did, and was told to try back in December.
Finally, Herman is scheduled to get his vaccine later this month.
“There are all kinds of hoops to jump through, and it’s not user-friendly for a doctor who wants to give it to a patient,’’ said Dr. Rafael Harpaz, a medical epidemiologist and shingles specialist at the Centers for Disease Control and Prevention.
Harpaz, also a coauthor of the new study, said that there are about 1 million cases of shingles in the United States each year, with about half of those cases in people under the age of 60. The older the patient, the more likely he or she will also suffer a complication, known as post-herpetic neuralgia, a severe pain that lingers in about 20 percent of patients for months and sometimes years after the shingles rash and blisters have healed.
The chickenpox virus, known as varicella zoster, lies dormant in a person’s body for years after an initial infection, and for reasons that are not fully understood, can suddenly spring to life, travel down nerve fibers to the skin and reemerge with the pain, itching, tingling, and rash of shingles. Specialists believe the ailment is more common in older adults because their immune systems wane with age, allowing the virus to reactivate.
Shingles typically starts as an unusual pain, with itching or tingling in one area of the face or body. This can happen anywhere from one to five days before a rash appears in that area. The rash forms blisters in three to five days, which then scab over, and the rash usually clears within 10 to 15 days. Scabs may last up to a month.
“When we hear a patient describe a burning pain without any abrasion we always think this can be [an early symptom] of shingles,’’ said Dr. Joyce Jen, an internist at Beth Israel Deaconess Medical Center.
Sometimes that patient can be a doctor’s own parent.
Jen’s 85-year-old mother, who was recently visiting from New York, mentioned something about a painful patch on her face. Jen noticed what appeared to be the beginning of a rash and immediately got her mother started on an antiviral medication.
“I said, ‘My God, you have shingles,’ ’’ Jen said. “If I hadn’t known, she would not have seen a doctor until she got back to New York in five days and it would have been too late.’’
It’s not clear the antiviral is effective after 72 hours, she said, “but sometimes I will start it on someone who is elderly, to reduce the risk of complications.’’
The most common complication, the lingering pain of post-herpetic neuralgia, can be debilitating.
“I have seen people with such pain they need narcotic medication afterward,’’ Jen said. “They can’t work, they can’t function, and that can last months.’’
Another potentially serious complication is the kind of eye problem that Abraham, the Waltham librarian, has struggled with. Specialists say that when a shingles rash shows up on a patient’s forehead, tip of the nose or eyelid, it often ends up infecting the eye, too.
Cambridge-based ophthalmologist Dr. David Hinkle, who has treated Abraham, said that about 10 percent of the eye inflam mations he sees involve viruses from shingles or the herpes virus that causes common cold sores. In these cases, Hinkle said, he typically keeps patients on antivirals for at least one year because they often have another flare-up if they stop the medicine.
With our aging population, physicians expect to see increasing numbers of patients showing up with shingles, unless the vaccine becomes more accessible.
But they also expect that equation to eventually change, based on the introduction of another vaccine for a younger generation. Since 1995, when federal regulators approved the chickenpox vaccine, millions of children have routinely been vaccinated and that has significantly lowered the incidence of chickenpox, according to government data.
“Based on the best we now know, if the chickenpox vaccine continues to be offered to children, then after another 40 years or so, the risk of shingles would start going down considerably,’’ said Harpaz, the CDC shingles specialist.
A study published last week in the Journal of Infectious Diseases found that since the CDC started recommending a double dose of chickenpox vaccine for children in 2006, the effectiveness among a group of children studied in Connecticut jumped from 86 to 98 percent. But lead researcher, Dr. Eugene Shapiro, a Yale University professor of pediatrics, epidemiology, and public health, said the scientists still don’t know how long that extra protection might last.
Similarly, other researchers say the shingles vaccine is still so new, they don’t know whether adults will need to get a future booster shot.
“There is kind of an intuition that especially in the elderly with less robust immune systems, that the vaccine may not last indefinitely and you may need a repeated dose,’’ said Harpaz. “But right now it’s mostly intuition and guesswork.’’
Kay Lazar can be reached at firstname.lastname@example.org.