Your Health

Do you have the shingles virus?

Dormant bug generally found in people over 50 years of age

Do you have the shingles virus?

BY AUDRA KOLESAR
Winnipeg Health Region
Wave, March / April 2015

What is shingles?

Shingles is an infection caused by the same virus that causes chickenpox. This virus is called varicella zoster. You cannot develop shingles unless you have had a previous infection of chickenpox (usually as a child). Shingles is also called herpes zoster. This infection is most common in people over 60 years of age, but young people can have it as well.

How does it occur?

After you recover from chickenpox, the chickenpox virus stays in your body. It moves to the roots of your nerve cells (near the spinal cord) and becomes inactive (dormant). Later, if the virus becomes active again, the symptoms are called shingles.

What causes the virus to become active?

What exactly causes the virus to become active is not known. A weakened immune system seems to allow reactivation of the virus. This may occur with immune-suppressing medicines, with another illness, or after major surgery. The virus may also become active again after the skin is injured or sunburned. Emotional stress seems to be a common trigger as well. Shingles is more common in older adults and in people with weakened immune systems.

Factors that may increase your risk of developing shingles include:

  • Being older than 50
  • Having a disease that weakens your immune system such as HIV/AIDS or cancer
  • Undergoing cancer treatments such as radiation or chemotherapy
  • Taking certain medications: such as drugs that prevent rejection of transplant organs or prolonged use of steroids.

What are the symptoms?

The first sign of shingles is often burning, sharp pain, tingling, or numbness in or under your skin on one side of your body or face. The most common site is the back or upper abdomen. You may have severe itching or aching. You also may feel tired and ill with fever, chills, headache, and upset stomach.

After several days, you will notice a rash of small, clear, fluid-filled blisters on reddened skin. Within three days after they appear, the blisters will turn yellow, then dry and crust over. Over the next two weeks the crusts will drop off, sometimes leaving small, pitted scars. Some people will have shingles without ever developing the rash.

Because they tend to follow nerve paths, the blisters are usually found in a line, often extending from the back or flank around to the abdomen, almost always on just one side. Shingles usually doesn't cross the midline of the body. The rash also may appear on one side of your face. Some people have painful eye inflammations and infections.

In some cases, the pain can last for weeks, months, or years after the rash heals. This is called postherpetic neuralgia.

Is shingles contagious?

You cannot get shingles from someone else, but you may get chickenpox from contact with shingles blisters if you have not had chickenpox before. You can pass the varicella zoster virus to anyone who isn't immune to chickenpox; they will develop chickenpox, not shingles. The shingles virus is in the blister fluid. The virus can spread by direct contact with a blister. It can also be spread by indirect contact, for example, if you use a washcloth that has blister fluid on it.

If you develop shingles it is important to avoid physical contact with anyone with a weak immune system, newborns or pregnant women.

Localized shingles has a much lower rate of transmission and is rare if lesions are covered with clothing or dressings. Disseminated or widespread shingles may spread through airborne, droplet contact with respiratory secretions as well.

How is shingles diagnosed?

Your health-care provider will ask about your symptoms and examine you. Your provider may order lab tests to look for the virus in fluid from a blister.

How is it treated?

It is best to start treatment within 24 to 48 hours after symptoms start. Home care includes:

  • Putting cool, moist washcloths on the rash.
  • Taking non-prescription painkillers, such as acetaminophen.

Your health-care provider may prescribe:

  • An antiviral drug, such as acyclovir, to speed recovery and lessen the chance of prolonged symptoms from nerve inflammation.
  • Stronger medicine for pain if non-prescription painkillers are not helping enough, antibacterial salves or lotions to help prevent bacterial infection of the blisters.
  • Corticosteroids.

How long will the effects last?

The rash from shingles will heal in one to three weeks and the pain or irritation will usually disappear within three to five weeks.

If the virus damages a nerve, you may have pain, numbness, or tingling for months or even years after the rash is healed. This is a condition called postherpetic neuralgia. It is most likely to occur after a shingles outbreak in people over 50 years old. Antiviral medicine prescribed at the time the shingles is diagnosed and taken for seven days can help prevent this problem.

When shingles occurs on the head or scalp, symptoms can include headaches and weakness of one side of the face (causing that side of the face to look droopy). Even if you have a lot of weakness of the face muscles, the symptoms usually go away eventually, although it may take many months.

Other complications from shingles can include:

  • Vision loss: shingles in or around the eyes can cause painful eye infections that may result in vision loss.
  • Neurological problems: depending on which nerves are affected, you may experience inflammation of the brain (encephalitis), facial paralysis or hearing or balance problems.
  • Skin infection: blisters may get infected.

How can I take care of myself?

  • Take a pain-relief medicine such as acetaminophen. Take other medicine as prescribed by your health-care provider.
  • Put a cool compress on the rash (such as a cool, moist washcloth).
  • Rest in bed during the early stages if you have fever and other symptoms.
  • Try to avoid having clothing or bed linens rubbing against the rash, which might irritate it.

See your health-care provider if:

  • You develop worsening pain or fever.
  • You develop a stiff neck, hearing loss, or changes in thinking and reasoning.
  • The blisters show signs of bacterial infection, such as increasing pain or redness, or milky yellow drainage from the blister sites.
  • The blisters or rash are close to the eyes or you have pain in your eyes or difficulty looking at bright lights.
  • You have trouble walking.
  • You have trouble breathing or a severe cough.

How can I help prevent shingles?

If you have never had chickenpox, you can get a shot to help prevent infection with the chickenpox virus. A vaccine, called Zostavax, is now available. The vaccine can help prevent or lessen the symptoms of shingles. It cannot be used to treat shingles once you have it. It is recommended for people who have either been immunized against chickenpox or who have had chickenpox. The National Advisory Committee on Immunization (NACI) recommends Zostavax for the prevention of herpes zoster and its complications in persons 60 years of age and older without contraindications. The herpes zoster vaccine is not currently funded by Manitoba Health. Speak with your primary care provider about this vaccine and if it's appropriate for you. You can protect your immune system and lessen your chances of getting shingles by trying to keep your stress under control.

Audra Kolesar is a registered nurse and manager with Health Links - Info Santé, the Winnipeg Health Region's telephone health information service.

The information for this column is provided by Health Links - Info Santé. It is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a health-care professional. You can access health information from a registered nurse 24 hours a day, seven days a week by calling Health Links - Info Santé.

Call 204-788-8200 or toll-free 1-888-315-9257.

Wave: March / April 2015

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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