Shingles
Shingles, also called herpes zoster, is caused by a reactivation Of varicella zoster, the same virus that causes chickenpox. Chickenpox symptoms disappear within about two weeks. However, the varicella zoster virus enters nerve cells where it remains inactive, Often for as many as 30—40 years. If the virus is reactivated, the individual develops shingles. The mechanism for reactivation is not well understood, but it appears to be connected to weakening of the immune system. Most shingles develop in people over age 60 years. although the virus can reactivate in much younger people who are immunocompromised (e.g., HIV infected; receiving chemotherapy). Shingles is a painful but not life-threatening disease. The first sign is itching, burning, or a painful sensation on the skin. This is followed in one to five days by a rash that usually develops only on one side of the body. The rash is accompanied by pain and often headache and low fever. The rash evolves into fluid-filled blisters that crust over in about two weeks. About 20 percent of people who develop shingles experience long- lasting pain called postherpetic neuralgia (PHN) so severe that it interferes
About 20 percent of people who develop shingles experience long- lasting pain called postherpetic neuralgia (PHN) so severe that it interferes with activities such as bathing, dressing, and sleeping. Pain usually is in the area where the rash was present and can last for months after the rash disappears. As of 2()18, there was no treatment for PHN. About 15 per- cent of people who develop shingles have blisters in the eye area. A few of these people develop permanent vision deficits. About one in three people will develop shingles during their lifetime. An estimated 500,000 to I million cases occur in the United States each year. People who live to age 85 have a 50 percent chance of developing shingles. Most people have only one outbreak, although repeat outbreaks are possible, especially in immunocompromised individuals. Shingles is not contagious; it cannot be passed from person to per- son. However, if a person who has never had chickenpox or has not been vaccinated against the disease comes into direct contact with fluid from shingles blisters (e.g., a grandparent with shingles holding a child not vaccinated against chickenpox), that person may become infected and develop chickenpox. Administration of Shingles Vaccine Until 2017, there Was Only One shingles Vaccine, Zostavax, approved for people over age 50 years in the United States. Zostavax contains the same live attenuated virus as varicella vaccine given to prevent chicken- pox, except that the shingles vaccine is 14 times stronger than the dose given to immunize against chickenpox. In October 20 1 7, a second shingles vaccine, Shingrix, was approved by the FDA and recommended by ACIP for adults over age 50. Shingrix is a recombinant subunit vaccine derived from genetically engineered Chinese hamster ovary cells. It requires two doses, the second two to six months after the first. The original shingles vaccine, Zostavax, is just over 50 percent effective in preventing shingles, but it is 67 percent effective in preventing PHN. In clinical trials, Shingrix, was just over 90 percent effective in preventing shin les and reducing PHN for at least four ears. As of 2018 the CDC
was recommending revaccination with Shingrix for individuals who were originally vaccinated with Zostavax, as well as vaccination with Shingrix of all unvaccinated individuals over age 5() years. Adverse Effects Both shingles vaccines cause mild adverse effects. The most common are transient pain, swelling, itching, and redness at the injection site, and muscle ache or headache. A few people vaccinated with Zostavax develop a mild rash. Special Populations Certain medical situations may change the recommended administration of shingles vaccine. Individuals should discuss any conditions that may alter use of shingles vaccine with their physician.
Zostavax contains gelatin and the antibiotic neomycin. People who have had a severe allergic reaction to either of these or other vaccine components or to chickenpox vaccine should not be vaccinated with Zostavax_ Shingrix does not contain either antibiotics or gelatin. People who have diseases and disorders that compromise the immune system (e.g., HIV infection), are taking immune-suppressant drugs, have certain blood and lymph cancers, or are receiving chemotherapy
\or radiation should not be vaccinated with Zostavax and should dis- cuss advisability of vaccination with Shingrix with their physician. • Moderately or severely ill individuals should wait until they are healthy to be vaccinated. • Individuals who are certain they have never had chickenpox or have never received a vaccine against chickenpox should not be vaccinated. What Makes This Vaccine Controversial? Shingles vaccine is not controversial except for individuals who reject all vaccines. However, many older people skip this vaccine or are unaware of it.
Shingles, also called herpes zoster, is caused by a reactivation Of varicella zoster, the same virus that causes chickenpox. Chickenpox symptoms disappear within about two weeks. However, the varicella zoster virus enters nerve cells where it remains inactive, Often for as many as 30—40 years. If the virus is reactivated, the individual develops shingles. The mechanism for reactivation is not well understood, but it appears to be connected to weakening of the immune system. Most shingles develop in people over age 60 years. although the virus can reactivate in much younger people who are immunocompromised (e.g., HIV infected; receiving chemotherapy). Shingles is a painful but not life-threatening disease. The first sign is itching, burning, or a painful sensation on the skin. This is followed in one to five days by a rash that usually develops only on one side of the body. The rash is accompanied by pain and often headache and low fever. The rash evolves into fluid-filled blisters that crust over in about two weeks. About 20 percent of people who develop shingles experience long- lasting pain called postherpetic neuralgia (PHN) so severe that it interferes
About 20 percent of people who develop shingles experience long- lasting pain called postherpetic neuralgia (PHN) so severe that it interferes with activities such as bathing, dressing, and sleeping. Pain usually is in the area where the rash was present and can last for months after the rash disappears. As of 2()18, there was no treatment for PHN. About 15 per- cent of people who develop shingles have blisters in the eye area. A few of these people develop permanent vision deficits. About one in three people will develop shingles during their lifetime. An estimated 500,000 to I million cases occur in the United States each year. People who live to age 85 have a 50 percent chance of developing shingles. Most people have only one outbreak, although repeat outbreaks are possible, especially in immunocompromised individuals. Shingles is not contagious; it cannot be passed from person to per- son. However, if a person who has never had chickenpox or has not been vaccinated against the disease comes into direct contact with fluid from shingles blisters (e.g., a grandparent with shingles holding a child not vaccinated against chickenpox), that person may become infected and develop chickenpox. Administration of Shingles Vaccine Until 2017, there Was Only One shingles Vaccine, Zostavax, approved for people over age 50 years in the United States. Zostavax contains the same live attenuated virus as varicella vaccine given to prevent chicken- pox, except that the shingles vaccine is 14 times stronger than the dose given to immunize against chickenpox. In October 20 1 7, a second shingles vaccine, Shingrix, was approved by the FDA and recommended by ACIP for adults over age 50. Shingrix is a recombinant subunit vaccine derived from genetically engineered Chinese hamster ovary cells. It requires two doses, the second two to six months after the first. The original shingles vaccine, Zostavax, is just over 50 percent effective in preventing shingles, but it is 67 percent effective in preventing PHN. In clinical trials, Shingrix, was just over 90 percent effective in preventing shin les and reducing PHN for at least four ears. As of 2018 the CDC
was recommending revaccination with Shingrix for individuals who were originally vaccinated with Zostavax, as well as vaccination with Shingrix of all unvaccinated individuals over age 5() years. Adverse Effects Both shingles vaccines cause mild adverse effects. The most common are transient pain, swelling, itching, and redness at the injection site, and muscle ache or headache. A few people vaccinated with Zostavax develop a mild rash. Special Populations Certain medical situations may change the recommended administration of shingles vaccine. Individuals should discuss any conditions that may alter use of shingles vaccine with their physician.
Zostavax contains gelatin and the antibiotic neomycin. People who have had a severe allergic reaction to either of these or other vaccine components or to chickenpox vaccine should not be vaccinated with Zostavax_ Shingrix does not contain either antibiotics or gelatin. People who have diseases and disorders that compromise the immune system (e.g., HIV infection), are taking immune-suppressant drugs, have certain blood and lymph cancers, or are receiving chemotherapy
\or radiation should not be vaccinated with Zostavax and should dis- cuss advisability of vaccination with Shingrix with their physician. • Moderately or severely ill individuals should wait until they are healthy to be vaccinated. • Individuals who are certain they have never had chickenpox or have never received a vaccine against chickenpox should not be vaccinated. What Makes This Vaccine Controversial? Shingles vaccine is not controversial except for individuals who reject all vaccines. However, many older people skip this vaccine or are unaware of it.
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