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Shingles
Shingles

Shingles

Shingles is a condition associated with a painful, blistering rash. It is caused by the reactivation of the virus that causes Chickenpox (Varicella zoster). Generally the blistering rash occurs in one part of the body. It can result in persistent pain at the site of the blisters and scarring.

Once you have had chickenpox, the virus (Varicella zoster) stays in your body within the nerve cells. The virus can then become active once more, generally during times of body stress or infection.

It is estimated that the lifetime risk of getting shingles is 1 in 4.  Although shingles can occur at any age, tit is most common over the age of 50 years.

Transmission

The virus is spread through direct contact with the fluid from the blistering rash caused by shingles.

A person with active shingles can spread the virus when the rash is in the blister-phase. A person is not infectious before the blisters appear. Once the rash has developed crusts, the person is no longer contagious.

Shingles is less contagious than Chickenpox and the risk of a person with shingles spreading the virus is low if the rash is covered.

You cannot contract Shingles from being in contact with someone with Chickenpox infection, but you can develop Chickenpox infection form being in contact with someone that has shingles.

Symptoms

Before the onset of the rash you may experience itching, pain or abnormal skin sensations around the site to be affected. This is followed by the rash, which starts as red spots that then develop into blisters. The blisters can take up to 4 weeks to fully heal.

There may be associated symptoms such as headache, feeling tired and fever.

Complications

Shingles can lead to:

  1. Post Herpetic Neuralgia-this is persistence of the pain at the infection site. The pain can be shooting, burning or like electric shocks and skin is very tender to touch. The pain is debilitating and there is no treatment or cure for it. It can take months or even years to resolve.
  2.  Visual disturbance or loss caused by shingles infection of the eye.
  3. Encephalitis (inflammation of the brain) or meningitis (inflammation of the lining of the brain).
  4. Superimposed bacterial infection of the skin.
  5. Loss of muscle function if the nerve affected is motor neurone. For example, facial paralysis from infection of the facial nerve.

Treatment

Anti-viral medications can be prescribed if diagnosed in the early stages to reduce the duration and severity of an attack.

Prevention

The best way to prevent shingles is to get vaccinated. There is a safe and effective vaccine, which is available privately to anyone over the age of 50 years of age, not eligible under the NHS immunisation programme.

The Shingles Vaccine

The shingles vaccine contains a weakened strain of varicella zoster virus. Based on a large study of more than 38,000 adults over the age of 60 years, it was found to reduces the risk of shingles by 51% and the risk of post herpetic neuralgia by 67%. In those over 70 years of age, the reduction in risk was 38% and 66.8% respectively.

Current National Stock Shortage of Zostvax 

No stock available at present-Flagship London Clinics Moorgate and Oxford Circus and following clinics

  • Ashwell
  • Bury St Edmunds. 
  • Bristol
  • East Greenwich
  • Norwich
  • New Cross
Limited supply at other locations. 

Inclusions

The vaccine can be given to:

  • Anyone over the age of 50 years for the prevention of shingles infection and post herpetic neuralgia.

Schedule

AgeMethod of AdministrationNumber of dosesBooster requirements
From 50 yearsIntramuscular injection or Subcutaneous injection to the deltoid1Unknown

The full duration of protection following vaccination is not known, but the latest data suggest the vaccine lasts for about 5 years. It is currently not known if booster doses are required.

Exclusions

The vaccine must not be given to:

  • Anyone with active shingles infection
  • Anyone with suppressed immune system due to disease process or drugs.
  • Pregnant women
  • Previous history of severe allergic reaction to the vaccine or any of it’s ingredients (see FAQ section)
  • Acute infection with fever (greater than 38.5 degrees Celsius)
  • Active untreated Tuberculosis

Special Considerations

The vaccine cannot be used to treat shingles infection or post herpetic neuralgia-only to reduce the likelihood of them occurring in the first place.

It is currently advised that you should wait 1 year after recovery from an episode of shingles before you have the vaccination. This is because following an infection, you get a natural boost in your immune response, which may make the vaccine less effective.

If you have 2 or more episodes of shingles in a year, you need to be assessed by a specialist prior to being considered for vaccination.

If you are on antiviral treatments by mouth or have received these treatments by injection, such as Aciclovir, you must wait 48 hours  after stopping the medication before receiving the vaccine can be given. This because the antiviral medication may reduce the effectiveness of the vaccine virus. This does not apply to topical antivirals.

Pregnancy

The shingles vaccine cannot be given to pregnant women. Additionally, pregnancy should be avoided for 1 month after receiving the vaccination.

Breast Feeding

It is not known if the vaccine virus is transmitted in breast milk and thus harm to the baby cannot be eliminated. Therefore, it should not be given to breast feeding mothers.

Common Side Effects

Injection site reactions-pain, redness, haematoma, hardening of the skin.

Headaches and pain in the limbs or joints

Fever

Rarely-Chickenpox like illness with rash-occurs in less than 1 per 10,000 people vaccinated

If a shingles-like rash or Chickenpox-like rash occurs, this needs to be assessed by a doctor and a swab taken to check if the vaccine virus is responsible.

Risk of transmission

There have been no documented cases in clinical trials of the transmission of the vaccine virus to non immune individuals. However, as the vaccine contains the same virus at a higher dose than the Chickenpox vaccine and has there have been isolated cases of transmission following Chickenpox vaccination, it is best to avoid close contact for 6 weeks with any of the following individuals, especially if a rash is present:

  • Pregnant women who have never had Chickenpox infection
  • Newborn babies (those from 0 to 28 days old)of mothers who have never had Chickenpox infection
  • Anyone with poor immune system.

Interactions with Other Vaccines

Shingles vaccine can be given at the same time as:

  • Diphtheria, Tetanus, polio vaccine
  • Influenza vaccine
  • All travel vaccines apart from Yellow Fever (see below) 
  • Pneumonia vaccine, including PPV-23.
Shingles Vaccine and MMR vaccine

As with the Chickenpox vaccine, the Shingles vaccine should be given on the same day as the MMR vaccine or separated by 4 weeks.

Shingles Vaccine and Yellow Fever Vaccine

There is limited evidence as to whether the vaccines interact and therefore, it is best to leave a 4 week interval between the vaccines.

 

Frequently Asked Questions

1) Is the vaccine safe?

The vaccine has been used in the US since 2006 and there have been no safety concerns. The most commonly reported side effects after vaccination is headache, or redness, swelling, pain or tenderness where the shot was given.  These symptoms are mild to moderate in intensity.  In rare cases, people who got vaccinated experienced a blister-like rash; some were found to have been caused by the vaccine.

2) Can I have the vaccine if I feel unwell?

The vaccine cannot be given if you have a fever. If there is a minor illness, such as a cold or cough, then the vaccine can be give, provided the clinician feels it is beneficial to do so in the consultation. 

3) Can I have the vaccine if I have just recovered form shingles infection?

Although the vaccine can be given to people who have had shingles vaccine, it is advisable to wait until all your symptoms have resolved. As you get a natural immune boost following shingles infection, it is best to wait for 1 year after this episode before having the vaccine. Vaccinations given earlier than this time may not be as effective. You cannot have the vaccine if you have ongoing symptoms of shingles. 

4) Can I have the vaccine if I have never had Chickenpox infection?

In temperate climates like the UK, the majority of the population will have had Chickenpox infection (estimated 95%). It may be that you did not develop obvious symptoms or had very mild infection. Therefore, the vaccine is still likely to be beneficial. However, if you are unsure, you can get tested for immunity to Chickenpox infection and the decision can be made based on the results. Shingles does not occur in individuals who have never had Chickenpox infection.

5) Am I infectious after getting the vaccine?

There has been no documented cases of transmission of the Shingles vaccine virus. However, we know this can occur with Chickenpox vaccine and the shingles vaccine contains the same virus strain. See section on risk of transmission for full advice.

 

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