Herpes Zoster (Shingles) Information for Ob-Gyns
The lifetime risk of developing shingles is 32% for individuals in the United States, and 50% of individuals who live until the age of 85 years will develop singles. Herpes zoster, or shingles, is a reactivation of the latent varicella zoster (chicken pox) virus, which most adults had as children. Herpes zoster is characterized by pain and a typically unilateral rash lasting up to 4 weeks. The most common complication of herpes zoster is postherpetic neuralgia (PHN), a long-term effect of shingles that is characterized by pain that persists in the area where the rash was present after the rash has resolved. While most shingles symptoms clear, 20% of individuals will develop postherpetic neuralgia.
Zoster vaccination data indicate a 51% decrease in the number of cases of shingles with vaccination, a 61% reduced burden of illness due to herpes zoster, and a 67% reduction in the incidence of postherpetic neuralgia. There is only one FDA-approved shingles vaccination. The vaccine is given in a single dose and is recommended for adults aged 60 years or older, including people with chronic medical conditions (unless a contraindication or precaution exists for their condition). Provisional ACIP recommendations advise that the vaccine should be given whether or not the person has had a previous diagnosis of shingles.
As with any live-attenuated vaccine, none of the varicella-containing vaccines should be given to pregnant women. Nonpregnant women who are vaccinated should avoid becoming pregnant for one month following each injection.
The CDC has specific information for Health Care Providers concerning Herpes Zoster.
Herpes Zoster (Shingles) Information for Patients
Herpes zoster (shingles) is an infection with the varicella zoster virus (VZV) that causes a painful skin rash usually affecting one side of the face or body. Some people feel pain or itching in the area where the rash is going to appear. Blisters from the rash form scabs after about 1 week, and the rash usually clears up in 2–4 weeks. Shingles can also cause fever, headache, chills, and stomachache. Shingles can cause vision loss when it affects the eyes.
Shingles is caused by the same VZV that causes chickenpox. In people who have had chickenpox, the virus stays in the body in an inactive state. Though no one knows why, the virus can become active again. This usually happens after age 60 years, but people of all ages can develop shingles. The risk of getting shingles increases with age. Some people with shingles have a long-term side effect called postherpetic neuralgia (PHN). PHN causes burning pain of the skin. The risk of developing PHN also increases with age.
Almost 1 out of every 3 people will get shingles. After age 85 years, 1 out of every 2 people will get it. Most people get only one case of shingles in their lifetime, but some people get it more than once. Shingles cannot be spread from person to person, but people who have never been exposed to VZV can get chickenpox if they come in contact with open blisters from someone with shingles.
The best way to prevent shingles and PHN is by getting the vaccine. The Centers for Disease Control and Prevention (CDC) recommend that adults age 60 years and older get the vaccine. Zostavax is the only shingles vaccine approved by the U.S. Food and Drug Administration. This vaccine contains live virus. It is safe for people with long-term health problems. Even people who have had shingles before can get the vaccine. For those who have had shingles, it is best to wait until the rash has cleared before getting the vaccine. A single dose is recommended.
Some people should not get the vaccine. The shingles vaccine should not be given to pregnant women or women who are trying to become pregnant within 1 month.
Other groups who should not get the shingles vaccine include those who:
• Have had a severe allergic reaction to gelatin or the antibiotic neomycin
• Have human immunodeficiency virus or another disease that affects the immune system
• Take long-term steroids
• Are undergoing cancer treatment with radiation or chemotherapy
• Have had a history of certain bone marrow cancers, such as leukemia or lymphoma.
Your health plan may or may not cover the vaccine. This vaccine is covered under Medicare Part D.
Visit the CDC's Herpes Zoster information pagefor more information.