Shingles: Who gets it and how it is treated

UAB infectious disease specialist Molly Fleece, M.D., says that, if you ever had chickenpox, you could get shingles.

RS38314 Molly Fleece 2 scrPhotography: Lexi CoonShingles can be a painful and debilitating disease, affecting one out of three people in the United States.

Molly Fleece, M.D., assistant professor with the University of Alabama at Birmingham Marnix E. Heersink School of Medicine, says age is a significant risk factor, with about 20 percent of cases occurring between 50-59 years and 40 percent occurring in adults over the age of 60.

“Immunocompromised patients are at increased risk of reactivation of the Varicella-zoster virus that causes shingles,” Fleece said. “This includes patients who have received organ transplants, certain immune modifying therapies, chemotherapy for cancer, high-dose or prolonged corticosteroids, and in persons living with HIV.”

Shingles symptoms

• Pain, itching or tingling of the skin
• Painful rash of blister-like sores, usually on one side of the body, often on the face or torso
• Fever
• Headache
• Chills
• Upset stomach
Source: CDC

She adds that immunocompromised patients are at an increased risk for not only developing shingles but also more frequent episodes of shingles, as well as severe complications. These severe complications include more generalized herpes zoster rash and organ involvement (like pneumonia, hepatitis, encephalitis), the latter becoming a life-threatening emergency.  

Fleece says that, if you ever had chickenpox, you could get shingles; but there are treatment options.

“The general management of herpes zoster includes antiviral therapy and analgesia for nerve pain,” Fleece said. “Prompt initiation of antiviral therapy — within 72 hours of symptoms’ developing — can reduce the severity and nerve pain that can occur as a result of shingles.”

Common oral antiviral medications include valacyclovir or acyclovir and are generally prescribed for seven days. In some severe and complicated cases, intravenous antiviral medications may be required at least initially or may require prolonged treatment.

The CDC recommends that adults age 50 years or older receive two doses of the shingles vaccine Shingrix to prevent the development of shingles, as well as reduce the likelihood of complications from shingles, like post-herpetic neuralgia. These two doses should be separated by two to six months. 

Vaccination is also recommended in immunocompromised patients age 19 years or older who are at an increased risk of developing shingles. 

When vaccine is indicated, it should be given even if the person has a history of prior shingles. 

However, the vaccine should not be received at the same time as an active shingles episode.

Fleece says that 1-6 percent of people may experience a second episode of herpes zoster or shingles in their lifetime. 

“This is more common among immunocompromised people and in women,” Fleece said.