Even a relatively minor case of shingles is a miserable experience, not easily forgotten. Often preceded by a day or two of skin sensitivity, itching and tingling, the rash of small blisters spreads across the skin, exquisitely painful to the touch. Most often, it appears on the torso or back, although it can affect any area. Because it travels along neurologic pathways, it is typically confined to just one side of the body.
The rash may last a week, two weeks or longer, accompanied by fever, nausea, and general aches and pains. Beyond that, shingles — increasingly common as we age — can cause lasting and sometimes debilitating pain known as postherpetic neuralgia, which may linger for months or years. Other serious complications can include loss of vision, brain inflammation and more.
Last fall, the U.S. Food and Drug Administration approved a new shingles vaccine called Shingrix. It takes the place of the Zostavax vaccine that’s been available since 2006. Shingrix is thought to be more than 90 percent effective in preventing shingles, compared to Zostavax’s 51 percent efficacy. Its protection is also thought to last much longer, and most people will never need another dose.
The U.S. Centers for Disease Control and Prevention now recommends a Shingrix vaccine, in two doses, for all healthy adults aged 50 and older, including those who previously got the Zostavax vaccine.
In South Blue Hill, children’s book author Susan Yaruta-Young, who is 66, watched her husband’s case of shingles worsen over the course of a few days, and it made a believer of her.
“Our doctor had been nudging us about getting the shot,” she said in a recent phone conversation. “But we always thought of shingles as something sort of rare.” In fact, about one of every three Americans will develop shingles in their lifetime, according to the CDC, with the risk getting greater with age.
When she saw how sick her husband got, how uncomfortable and fatigued, Yaruta-Young decided it was time to get the vaccine.
“Part of it was just seeing what he was going through,” she said. “But some of it was ego, too — I didn’t want to have that rash someplace where people would see it.”
Her doctor phoned a prescription to her local pharmacy, and the next day she went in for the shot. Three days later, her shoulder was still achy, but getting better. She’ll get her follow-up dose later this summer.
Shingles, more correctly known as herpes zoster, is caused by the varicella virus, which also causes chickenpox. In the case of shingles, however, the virus has lain dormant for years, until it is suddenly reactivated. The trigger for that reactivation is not known, though it may be a response to stress or a weakening of the body’s immune system. Unlike many viral diseases, it is possible for an individual to suffer through shingles more than once.
Shingles itself is not contagious, but oozing blisters can transmit the virus to others, potentially causing chickenpox in infants or others who have not been vaccinated against that illness.
“Most people can just suck it up and get through [a case of shingles],” said longtime Bangor physician Frank Bragg, “but for others, it can really be life-changing.” The possibility of permanent vision loss and lasting neurologic pain means every case has the potential to be devastating.
Bragg strongly recommends a shingles vaccine for his older patients, in accordance with the CDC recommendations. Some people are wary, he said.
“The first thing they ask is how much it’s going to cost,” he said. “But anyone who’s ever seen the disease or known someone who’s had it is pretty likely to get the vaccine.”
The vaccine is pricey, typically running upwards of $200 for people not covered by Medicare or private insurance. Susan Yaruta-Young paid $46, after her Medicare Advantage plan picked up the largest part of the cost. Others may find their individual Medicare Part D doesn’t cover many vaccines, or pays very little toward them. Private insurance coverage varies widely and is subject to copays and deductibles, but in many cases it will cover all or most of this preventive service.
Despite the cost, Bragg said many people choose to invest in a vaccine rather than gamble on getting a case of shingles. The new Shingrix vaccine appears to be superior in many ways to the earlier Zostavax formula, he said, making it a more persuasive option. Reported side effects are few: in addition to local pain and tenderness, some people may experience fever, fatigue headache and nausea. People who have an active case of shingles should wait to get the vaccine.
Shingrix is proving so popular that the CDC recently included it on its list of vaccines in short supply, with some shipping delays expected through the end of June.
Semi-retired at 76, Bragg is coming due for his annual Medicare wellness visit and will ask his own doctor for the new vaccine.
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