Beware the shingles virus

CATHY STEPHENSON
Last updated 05:00 13/11/2012

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"I have two adult friends suffering from shingles, as well as another friend whose two young grandchildren have recently had the illness," writes Judith of Khandallah. "Could you shed some light on this condition, and what treatment is available?"

Shingles is certainly quite a complex condition and, although it is more common in the over-70s, it can affect people of any age, including children. About one in 20 of us will be affected at some point in our lives and it can cause very debilitating effects, lasting from a week to several months.

Shingles is an infection caused by varicella zoster, the same virus that causes chickenpox. After an infection of chickenpox, the virus can enter the nervous system and remain dormant for many years.

In some people, the virus can be re-activated and can travel along the nerve endings, causing the rash and pain of shingles.

It is not possible to get shingles if you have never had chickenpox.

The first sign of shingles is usually pain. The pain is distributed in a spinal nerve segment, often in a linear pattern along one side of the trunk or back. Less commonly, it can affect the limbs or face. The pain is often described as itching or burning. Two or three days after the pain starts, a visible red raised rash appears. Over the next week or so, this rash forms blisters and then crusts over, before healing. The pain and rash may be accompanied by fever, malaise, headache and chills. In some unlucky individuals, the pain can persist for months after the rash heals, and this phenomenon is known as post-herpetic neuralgia.

Anyone who has had chickenpox can develop shingles, but the following factors will increase your risk:

* Increasing age - it is estimated that 50 per cent of people who live until 85 will experience shingles some time in their lives;

* Immunosuppression - diseases that suppress the immune system, such as cancer or HIV;

* Radiation or chemotherapy;

* Certain medications, including steroids.

Shingles is contagious. If you have it, you can pass the virus on to anyone not immune to chickenpox. Once infected, they will develop chickenpox, not shingles.

This can be potentially dangerous for certain groups of people so, if you have shingles, it is important to avoid newborn babies, pregnant women, and very elderly, sick or frail people.

Treatments can help reduce the severity and duration of your symptoms. The most effective drugs are antivirals, known as Acyclovir and Famciclovir. To get the most benefit, they need to be started as soon as possible after the onset of symptoms. Your doctor will also discuss ways to reduce the pain, which can be excruciating. Standard pain relief such as paracetamol or codeine may be helpful, but isn't always, so you may be prescribed pain "modifying" drugs, including Amitriptyline or Gabapentin.

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Other simple measures that will help you recover more quickly include:

* Rest;

* Cool baths, or cool compresses on the rash;

* Topical application of a local anaesthetic cream;

* Antihistamine tablets, available over the counter, can help to relieve itch in some people;

* Acupuncture, especially for pain relief.

You may be able to manage the symptoms yourself at home, especially if they are mild.

However, if you are feeling very unwell, or the rash is near your eye, it is important to see your doctor to avoid complications.

If you have never had shingles, it is worth considering paying for the shingles vaccine, known as Zostavax. It can reduce your chance of getting shingles and of developing post-herpetic neuralgia.

Although it is recommended for anyone over 50 who has previously had chickenpox, unfortunately supplies are limited so it may not be available in your area.

The other option, if you or your children have been lucky enough to escape chickenpox so far, is the varicella vaccine (known as Varivax or Varilrix).

It can reduce the chance of complications and reduce the severity of chickenpox or shingles.

- Cathy Stephenson is a general practitioner, medical forensic examiner and mother of three. If you have a question for her email features@dompost.co.nz

- The Dominion Post

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