What you need to know about shingles

Fiona Sheppard* noticed her foot was really hurting, she then spotted a nasty rash. She went to see her doctor about it. He diagnosed shingles, an illness one in three Australians aged 50+ will experience.

Fiona was lucky. She sought medical help as soon as she decided she needed to do something about the intense pain and she was able to be prescribed medication to treat it effectively.

“If you’re getting pain and then you develop blisters, you should immediately see your GP,” says Professor Michael Woodward, an expert in the field. “The antiviral agent to treat shingles only work if they’re administered within 72 hours. In fact, they work best within 24 hours.”

While shingles is often a treatable ailment for many sufferers, it can be a debilitating illness, affecting your energy levels, mood swings, pain levels and in some cases can cause serious complications that may continue for months, if not years.

Ask anyone who has had shingles, and they will most probably tell you it’s a malady you won’t forget in a hurry. While the physical symptoms may go within about three weeks, it can affect your everyday life for far longer, particularly if you’re working or leading an active social and family life. In other words, it can seriously knock you for six.

Yet it’s hardly as well known as the flu, gastroenteritis, bronchitis, pneumonia or other maladies which can flatten 50+ Australians.

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Shingles can affect your energy levels, mood swings and pain levels

So what is it? And why are people over 50 more susceptible to it? As many boomers would have had chickenpox at a younger age, they may be unaware that the zoster virus (shingles) can lie dormant in nerve roots near the spine for years. The virus can be reactivated, causing shingles. This can happen especially if you’re rundown and your immune system is vulnerable.

Shingles (the outbreak of the blisters and rash) can occur anywhere on the body, though it tends to be isolated to a limb or on one side of the torso. If you have shingles on your face, for example, you won’t get it on your body and vice versa.

Professor Woodward says one in three Australians will experience shingles in their lifetime, though few know much about it or its symptoms. “Public awareness of the illness is limited,” he says.

“For many, it is a minor inconvenience, but for others it can be serious,” he says. “There are figures that suggest it affects women more than men.

“It affects older people because the immune system is less efficient [as you age]. Almost everyone in our society has had chickenpox when they’ve been younger, though in decades to come shingles will be less prevalent because we now have the chickenpox vaccine. But that is going to take decades.”

You may also be more vulnerable to shingles if you’re being treated for certain cancers, have recently had an organ or bone marrow transplant, have HIV/AIDS, are on drugs that suppress immunity or you’re undergoing high levels of stress.

It can also trigger depression or make you more at risk of stroke. “There is an increased risk of paralysis of the muscles because shingles can also affect the motor nerves,” says Professor Woodward. “The paralysis can be short-term or in some cases more permanent. There are many complications of shingles beyond a rash and some pain.”

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Thankfully there is a shingles vaccine readily available in Australia

A common yet little known complication of shingles is post herpetic neuralgia (PHN), a debilitating form of nerve damage pain. Current figures suggest that more than 50 per cent of those diagnosed with shingles will get PHN - and this can occasionally go on for years. It can seriously affect your quality of life with PHN leading to other chronic diseases like type 2 diabetes, depression and heart failure.

“What happens there is that the outbreak of the chickenpox virus down the nerve root resets the pain system, and we don’t exactly understand why,” says Professor Woodward.

“There is intense ongoing pain even after the initial shingles has gone away. It can produce constant pain and it is also possible that certain stimuli can exacerbate it such as wind, a hairbrush or clothing rubbing against the skin."

“It can cause some of the most extreme pain you can imagine,” he adds. “Studies have found it is more intense in some cases that childbirth for women or having a traumatic fracture for either men or women. It can be very, very disabling.”

Shingles can also affect the eyes and in 10-25 per cent of cases, the illness can lead to prolonged or permanent pain, facial scarring and loss of vision.

The good news is that there is a shingles vaccine readily available in Australia and is highly effective with studies showing more than 60 per cent of those vaccinated don’t develop the illness, says Professor Woodward.

The vaccination, however, is not subsidised by the Pharmaceutical Benefits Scheme (PBS) for anyone aged between 50 and 70, and at about $250 a vaccine, doesn’t come cheap.

Those aged between 70 and 80 are eligible to be vaccinated and be covered by the PBS. Professor Woodward says that there has been a public outcry from time to time about the cost of the vaccine, particularly as anyone aged 55, for example, is likely to need a booster vaccination at 60 and 65, but so far it has fallen on deaf ears.

“People aged between 50 and 70 are going to have to pay for the vaccine out of their own pocket,” he says. “From November 1, it will be subsidised for those aged over 70,” he says. “It is a shame that the government has not looked at providing it for younger Australians. It should be made universally available, especially to anyone over 60.”

Professor Woodward says it would be good to develop a national registry for adults who have been vaccinated to provide medical staff with up-to-date patient information. “People as they get older can have trouble with their memory,” he says, “and remembering what vaccines you’ve had. The government is talking about setting up a registry.”

*name has been changed

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