Shingles – to vaccinate or not to vaccinate (and my experience)

That’s what’s being discussed by a NY Times article today, titled “A Vaccine as an Option to Keep Shingles at Bay.” Unfortunately the vaccine is new, so a lot of the effects are unknown – that is, no one really knows how long the immunity lasts, and if there are any long-term side effects. Still, it’s something to consider if you’re worried about suffering from shingles.

If you don’t know what “shingles” is, consider yourself lucky. It’s a reactivation of the Varicella Zoster Virus – the same virus that causes chickenpox. But when it reactivates (usually in older people with weakened immune systems) instead of breaking out in those characteristic red blisters all over, shingles usually results in a more localized blister. It’s localized because after suffering from chickenpox, the virus retreats to a nerve, and upon reactivation will generally effect only that nerve. The area of skin supplied by these nerves is called a “dermatome”, and if you look at the picture below you can see how these are distributed across the body (borrowed from the website http://www.thecompounder.com, which I’m pretty sure was borrowed from Frank Netter’s Atlas of Human Anatomy):
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So the virus hangs out in a nerve root near the spine, and upon reactivation affects a strip of skin that correlates to the strips in that picture. If it presents classically like this, it’s probably pretty easy to identify by a doctor or nurse, although the NY Times article describes a woman who had to make a few trips to the ER and Urgent Care clinic before getting diagnosed and treated.

I can say from personal experience that you do not want to suffer from shingles. I had an outbreak at 23, which I’m assuming is pretty rare. It’s associated with old and immunocompromised patients, but it can also erupt because of extreme stress, which is what I believe happened in my case. I had just moved across the country, started medical school, and ‘came out’ to my very Christian parents about my atheism – there was definitely a significant amount of stress in my life at the time, though I was trying to manage it by exercising and eating relatively healthy (obviously it wasn’t enough!).

I had what I assumed to be multiple bug bites or poison ivy (I’m an outdoorsy person), and decided to go to the doctor after the ‘bites’ wouldn’t heal and appeared to get worse. Fortunately my primary care doctor identified it immediately as shingles (literally, she took less than one second) and put me on retroviral therapy for a week to put the virus in check, but I’m not sure whether other doctors would be so quick to catch it in a younger patient, which I believe was part of the problem with the woman in the article who was repeatedly misdiagnosed (plus it was on her scalp which probably made it more difficult to see). The next few weeks were miserable, to put it mildly, as the blisters crusted over and went from causing a minor tingling sensation to spontaneous severe, sharp pain. Even after the spots healed and disappeared, I would still get random tingling or brief pain for months. Fortunately this disappeared, but in some individuals (the article says about 20%) this pain never goes away and is referred to as ‘postherpetic neuralgia’ (PHN). I feel very sorry for anyone who suffers from PHN – I think I would go crazy if I had to live with those sensations for the rest of my life.

So would I get a shingles vaccine? I think it’s sort of a moot point for me – having suffered from shingles already the odds of a second incident are small. Still, if I were older and in a risk group for an attack, I would probably get the vaccine. It’s worth the $200-300 not to experience the weeks of weird sensations and pain, and definitely worth it to avoid experiencing PHN.

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