The disease, Shingles or Herpes Zoster, is a very common illness among older adults. For many years researchers have been raising questions as to why this is the case.
The most common understanding among geriatricians is that we are dealing with a suppressed or less reactive immune system that tends to decline with aging. Since those who have been exposed to the chickenpox virus at a young age will continue to have the virus remain at the base of the dorsal root ganglia for many years, these previously infected persons can develop Shingles much later in life. The circumstances that stimulate the re-activation of the chickenpox viruses lying at the dorsal root ganglia is still not understood by researchers.
Nevertheless, Shingles is frequently associated with a very painful rash that usually occurs on one side of the face or body and lasts from 2 to 4 weeks. This neuropathic-like pain can last months and in some cases for years. Experiencing pain is the major reason why there has been a lot of interest in developing an effective vaccine that can reduce the development of Shingles, especially among the older adult population.
Shingles is caused by the Varicella Zoster virus, the same virus that causes chickenpox among children. Since a vaccine, that is similar to the recently developed vaccine for persons 60 years and older, has been given to children to prevent chickenpox, chickenpox is no longer seen very often among small children. Yet, one in three persons who have not been immunized for chickenpox as a child will develop Shingles during their lifetime. That equates to 1 million cases of Shingles in the United States annually. Since one in five persons who are infected with Shingles will experience post herpetic neuralgia after the rash clears, one can appreciate the importance of having a vaccine that can reduce Shingles infections among older adults.
In 2006 a vaccine for Shingles, known as Zostavax, was licensed in the USA for persons 60 years and older. Clinical trials have consistently demonstrated a 50% reduction of Shingles among immunized older adults. More importantly, among those who were immunized against Shingles but still experienced the disease, there was a significant reduction of post herpetic neuralgia.
The Zostavax vaccine is a live virus that is attenuated. Attenuation of a virus means the virus was altered so that the vaccine will not cause active chickenpox but stimulate the immune system to produce antibodies against the chickenpox virus. Thus, these antibodies will be activated by the chickenpox virus if one is exposed to the wild chickenpox virus in the community.
Over the years scientists have learned that Shingles can occur more frequently among persons with immune suppression such as persons with rheumatoid arthritis, systemic lupus erythematosus, and Crohn’s disease . The other co-morbid factor to these inflammatory diseases is the fact that many may be receiving steroids or other immune modulators that can suppress the immune system.
There are a number of medical conditions or situations where an individual may not be an appropriate candidate to receive an immunization for Shingles. Any concerns regarding receiving Zostavax should always be addressed with the patient’s primary care physician and/or pharmacists.
Since there is evidence demonstrating the decline in our immune system as we age, I would encourage everyone who is 60 years of age and older to consider receiving the Zostavax immunization. The medical research literature indicates that the Shingles immunization is most effective among those receiving the vaccine in their 60s, while those in their 70s and older will experience less benefit from the Zostavax immunization.
By Dr. Ken Brubaker
Dr. Kenneth Brubaker is a former Medical Director at Willow Valley Communities, and an innovative leader in caring for the elderly. Dr. Brubaker has been demonstrating his passionate approach to patient care since he joined the CCRC in 2004.
He was given the annual award from the American Medical Directors Association which recognizes one individual whose vision, passion, leadership, knowledge, and commitment succeed in taking patient care to higher levels of quality and excellence. Dr. Brubaker’s innovative work and commitment to infection control and wound care management were specifically cited.