Addressing misconceptions about herpes zoster.
Shingles, or herpes zoster (HZ), is a common viral infection that affects about 1 million individuals in the United States each year. Long considered to be primarily a health concern for the elderly, incidence rates are on the rise in younger age groups. Approximately half of the population that reaches 80 years of age will experience shingles, sometimes with complications that are long lasting and life changing.
Despite abundant available information about shingles, plenty of myths remain in circulation that can endanger not only individuals who are most at risk, but also the population at large. Drug Topics® addresses some of those misconceptions with the help of Jeffrey Cohen, MD, chief, Laboratory of Infectious Diseases at the National Institute of Allergy and Infectious Diseases.
Myth: Shingles is caused by a reinfection of the varicella zoster virus (VZV).
Fact: Shingles occurs when the opportunistic VZV, which has laid dormant in the body’s nervous system since an earlier episode of chickenpox, reactivates decades later and takes a different path. “During chickenpox, the virus spreads in the bloodstream and it infects skin potentially all over the body, as well as organs in the body,” Cohen explained. “But during reactivation in healthy people, the virus spreads from the ganglia along the nerves to the skin.”
Myth: The shingles rash is the worst aspect of the infection.
Fact: Although the rash is a painful and unsightly symptom, it typically resolves within a few weeks. However, in up to 20% of all shingles cases, patients develop a debilitating and far more serious condition known as postherpetic neuralgia (PHN). “Postherpetic neuralgia is unrelenting pain for weeks to months or even a year or more,” said Cohen, who calls it the major shingles concern. “There is clear medication for postherpetic neuralgia, but just like everything else in the elderly it has more side effects and it doesn’t truly get rid of all the pain.”
Myth: VZV can reactivate as shingles more than once.
Fact: Cohen said the vast majority of people who experience shingles have only 1 episode, although it depends primarily on an individual’s immune system. “Typically, if one gets shingles, it might be another 20 years before the immune system declines and doesn’t recognize the virus as strongly, and people can get a second episode,” he said.
Myth: Shingles is contagious.
Fact: Technically, no. What is highly contagious is the varicella zoster virus, which spreads easily through the air. If a person with no immunity to VZV is infected with it, they are likely to develop chickenpox. The virus will then go dormant in their nervous system, with the potential to reactivate at a later date. “If somebody in the family has zoster, keeping the lesions covered makes it less likely that it’s going to spread in the air,” Cohen advised.
Myth: If a person already has VZV in their body, little can be done to prevent shingles.
Fact: A highly effective vaccine called Shingrix has been proven to drastically reduce a person’s risk of developing shingles. “Shingrix is about 90% protective against zoster in people who are 70 and above, and about 97% in people who are 50 to 69 years old,” noted Cohen.
Shingrix is recommended for use in immunocompetent individuals age 50 and older, and is administered in 2 doses given 2 to 6 months apart. It is included on the CDC’s Advisory Committee on Immunization Practices’ 2021 recommended immunization schedule for adults.