Chickenpox is an annoying, itchy rash for children, but the virus that causes chickenpox can be a very serious health problem for older adults. Following childhood chickenpox, the virus goes into a dormant stage in the spinal cord. Old age or an impaired immune system can allow the virus to reappear in older adults as shingles, a very painful nerve disease.
A national study by the Department of Veterans Affairs found that a higher dose of the childrens chickenpox vaccine can help to prevent shingles in adults. When shingles did occur, the vaccine reduced the chronic pain of the nerve disease often associated with the infection.
Carol Kauffman, MD, chief of infectious disease at the VA Ann Arbor Healthcare System and a professor of internal medicine at the University of Michigan, says shingles is chickenpox reincarnated.
Among the elderly population, nearly all have had chickenpox as children. Its estimated that nearly 50 percent of these people will have had shingles if they reach the age of 85, she says.
Although it can occur in young adulthood, shingles occurs more frequently after the age of 60. About a million people develop shingles each year in the United States.
Shingles begins as a rash along a nerve route, which means it goes around one side of the body, or on one side of the face, but doesnt cross the midline. When it causes the rash, it also causes pain, which is a more serious condition than the blisters from the rash. The initial acute pain and chronic pain that follows, are serious problems with this infection. The blisters goes away in about a week and dont cause any problems.
Weve had patients who cannot stand to put on clothes. They come to the office and as soon as possible will take off their clothes in the area thats involved because just the light touch of clothing on the rash can be very painful, Kauffman says.
Treatment of shingles is easily accomplished with very safe anti-viral drugs that are administered for seven to 10 days. These treat the blisters and make the rash go away faster, but they do not prevent postherpetic neuralgia, which is the name given to the chronic pain that occurs after shingles.
Doctors suspected it would be more effective to have active immunity against the virus so shingles doesnt flair up, rather than to treat it once it has emerged. About 10 years ago, virologists at the Department of Veterans Affairs designed a study to look at the childrens chicken pox vaccine and see if it might prevent shingles in older adults.
The idea was to take people who had chicken pox as children, boost their immunity with the chicken pox vaccine, and see if this prevented shingles, Kauffman said. As it turns out, you need a larger dose of the vaccine than what is given to children, but the study showed the vaccine prevents shingles, the pain was prevented if you did get shingles, and the disease was much less strong than it would have been without the vaccine.
The study involved more than 38,000 volunteers throughout the United States, both veterans and non-veterans. It covered five years, with half the volunteers getting the vaccine and the other half getting a placebo. After five years, the results were that shingles was decreased by 50 percent. Those who did get shingles had about a 60 percent reduction in severity.
Very important is the fact that postherpetic neuralgia was reduced by two-thirds in the vaccine group, in comparison to the placebo group, Kauffman said.
She says that, as a result of this large study, an adult vaccine is under consideration for approval at the United States Food and Drug Administration. When the FDA approves it and a commercial vaccine for adults becomes available, the likely recommendation will be that adults over the age of 60 be vaccinated.
Source: University of Michigan Health System