Shingles in Older Adults

It's not possible to catch shingles from someone with the condition or from someone with chickenpox. However, you can catch chickenpox from someone with shingles if you haven't had chickenpox before. The blisters that form contain live virus

Shingles in Older Adults

It's not possible to catch shingles from someone with the condition or from someone with chickenpox. However, you can catch chickenpox from someone with shingles if you haven't had chickenpox before. The blisters that form contain live virus

Shingles is a viral infection that causes a painful rash. Although shingles can occur anywhere on your body, it most often appears as a single stripe of blisters that wraps around either the left or the right side of your torso. Shingles is caused by the varicella-zoster virus. It is the same virus that causes chickenpox. After you have had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain. Years later, the virus may reactivate as shingles.

While it isn't a life-threatening condition, shingles can be very painful. Vaccines can help reduce the risk of shingles, while early treatment can help shorten a shingles infection and lessen the chance of complications.

Shingles may also be referred to as herpes zoster. This type of viral infection is characterized by a red skin rash that can cause pain and burning. Shingles usually appears as a stripe of blisters on one side of the body, typically on the torso, neck, or face. Most cases of shingles clear up within two to three weeks. Shingles rarely occurs more than once in the same person.

Most adults live with varicella-zoster virus in their bodies and never get shingles. But, for about one in three adults, the virus will become active again. Instead of causing another case of chickenpox, it produces shingles. It is still a mystery what makes the virus go from inactive to active.

Causes of Shingles in Older Adults

Everybody had chickenpox as a young child in primary school or earlier. The fever, blisters, and itching lasted for a week or so, depending on how serious your case was. Once the blisters dried, you were no longer considered contagious and were allowed to return to school.

Now we know that the varicella-zoster virus that causes chickenpox never completely leaves your body, even after you return to perfect health. The virus is dormant, which means it is hiding or sleeping within the nerves beside your spinal cord. Years later, the virus particles can reactivate. They move outward along the nerve fibers until they reach the skin, at which point they cause the painful rash called shingles. The shingles rash covers only a small area on your body, and is always confined to one side. The lines of blisters follow the nerve fibers that grow outward from the spinal nerve roots under the skin.

  • If the virus particles were dormant in an area near the top part of your spinal cord, you may get blisters on your neck, face, head, mouth, eyes, or ears as they spread along the facial nerves.
  • If they were dormant somewhere in the middle of your back, your rash will probably form a narrow “belt”-like band that starts at the spine and comes around one side of your body to the front of the chest or abdomen. Viruses that were dormant towards the bottom of your back may migrate down the nerves of your legs and into your feet, causing patterns of blisters in those areas of your body.

Following factors are known to increase your risk of developing the condition:

  • Older age, especially being older than 60 years–the older you are, the higher the risk. This is the primary risk factor.
  • A weakened immune system, which can be caused by cancer treatment (chemotherapy or radiation), infection with HIV, long-term use of steroid medications, or treatment to prevent rejection of an organ transplant.
  • Even a single stressful life event can weaken your immune system. Your immune system is the part of your body that responds to infections. Age can affect your immune system. So can an HIV infection, cancer, cancer treatments, too much sun, or organ transplant drugs. Even stress or a cold can weaken your immune system for a short time. These all can put you at risk for shingles.
  • Physical stress such as having a cold or sunburn.
  • Your chickenpox infection occurred before you were one year old.

Symptoms of Shingles in Older Adults

Usually, shingles develops only on one side of the body or face and in a small area rather than all over. The most common place for shingles is a band that goes around one side of your waistline. Most people have some of the following shingles symptoms:

  • Burning, tingling, or numbness of the skin
  • Feeling sick i.e. chills, fever, upset stomach, or headache
  • Fluid-filled blisters that break open and crust over Skin that is sensitive to touch
  • Mild itching to strong pain
  • Itching
  • Sensitivity to light
  • Fatigue

Depending on where shingles develops, it could also cause symptoms like hiccups or even loss of vision. For some adults, the symptoms of shingles are mild. They might just have some itching. For others, shingles can cause intense pain that can be felt from the gentlest touch or breeze.

Complications from Shingles in Older Adults

  • Postherpetic neuralgia - For some people, shingles pain continues long after the blisters have cleared. This condition is known as postherpetic neuralgia, and it occurs when damaged nerve fibers send confused and exaggerated messages of pain from your skin to your brain.
  • Vision loss - Shingles in or around an eye (ophthalmic shingles) can cause painful eye infections that may result in vision loss.
  • Neurological problems - Depending on which nerves are affected, shingles can cause an inflammation of the brain (encephalitis), facial paralysis, or hearing or balance problems.
  • Skin infections - If shingles blisters aren't properly treated, bacterial skin infections may develop.

Treatment for Shingles in Older Adults

There’s no cure for shingles, but medication may be prescribed to ease symptoms and shorten the length of the infection.

  • Anti-viral medications including acyclovir, valacyclovir, and famciclovir – It reduces pain and speed recovery. Prescribed dose – 2 to 5 times daily (as recommended by a doctor)
  • Anti-inflammation drugs, including ibuprofen – It eases pain and swelling. Prescribed dose – after every 6 to 8 hours.
  • Narcotic medications or analgesics – It reduces pain. Prescribed dose - likely to be prescribed once or twice daily
  • Anticonvulsants or tricyclic antidepressants – It is good in treating prolonged pain. Prescribed dose - once or twice daily
  • Antihistamines, such as diphenhydramine (Benadryl) - It is recommended to treat itching. Prescribed dose - every 8 hours
  • Numbing creams, gels, or patches, such as lidocaine – It helps in reducing pain. Prescribed dose - can be applied as needed
  • Capsaicin (Zostrix) -   It helps reducing the risk of a nerve pain called post-herpetic neuralgia, which occurs after recovery from shingles. Prescribed dose - can be applied as needed.

Preventive Measures for Shingles in Older Adults

If you have shingles, you are contagious until the last blister has dried and scabbed over. To help prevent the virus being passed on, avoid sharing towels or flannels, swimming, or playing contact sports. You should also avoid work or school if your rash is weeping (oozing fluid) and can't be covered. If you have shingles, avoid:

  • women who are pregnant and haven't had chickenpox before as they could catch it from you, which may harm their unborn baby
  • people who have a weak immune system, such as someone with HIV or AIDS
  • babies less than one month old, unless it's your own baby, in which case your baby should have antibodies (proteins that fight infection) to protect them from the virus

Two vaccines may help prevent shingles i.e. the chickenpox (varicella) vaccine and the shingles (varicella-zoster) vaccine.

  • Chickenpox vaccine - The varicella vaccine (Varivax) has become a routine childhood immunization to prevent chickenpox. The vaccine is also recommended for adults who have never had chickenpox. Though the vaccine doesn't guarantee you won't get chickenpox or shingles, it can reduce your chances of complications and reduce the severity of the disease.
  • Shingles vaccine - People searching for shingles vaccine have two options: Zostavax and Shingrix. Zostavax has been shown to offer protection against shingles for about five years. It's a live vaccine given as a single injection, usually in the upper arm.

Shingrix is the preferred alternative to Zostavax as Shingrix offers protection against shingles beyond five years. It's a nonliving vaccine made of a virus component, and is given in two doses, with two to six months between doses. It is recommended for people age 50 and older, including those who have previously received Zostavax. Zostavax isn't recommended until age 60.

The most common side effects of either shingles vaccine are redness, pain, tenderness, swelling and itching at the injection site, and headaches. As with the chickenpox vaccine, the shingles vaccine doesn't guarantee you won't get shingles. But this vaccine will likely reduce the course and severity of the disease and reduce your risk of postherpetic neuralgia. The shingles vaccine is used only as a prevention strategy. It's not intended to treat people who currently have the disease. Consult your doctor about which option is right for you.

It's not possible to catch shingles from someone with the condition or from someone with chickenpox. However, you can catch chickenpox from someone with shingles if you haven't had chickenpox before. The blisters that form contain live virus. If a person who has never had chickenpox makes direct contact with an open blister or something with the fluid on it, they can contract the virus and develop chickenpox.

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Allie Leon, Chief Fun Officer

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