Shingles, a viral infection known for its excruciating pain, often manifests as a rash that feels like “being burned and electrocuted at the same time.” In Cantonese, the condition is referred to as sang se, or “growing snakes,” due to the way the rash seems to spread under the skin like a creeping serpent.
The term “shingles” is derived from the Latin word cingulum, meaning “belt,” as the rash often appears as a stripe around one side of the waistline. Though it may sound unfamiliar to some, shingles is a serious condition that affects a significant portion of the population, particularly older adults.
What Causes Shingles?
Shingles, also known as herpes zoster, is caused by the varicella-zoster virus (VZV), the same virus responsible for chickenpox. After a person recovers from chickenpox, the virus lies dormant in the body’s nerve tissues, sometimes reactivating later in life to cause shingles. Individuals who have had chickenpox are at risk, and in regions like Hong Kong, about 97% of adults aged 40 and older carry the VZV antibodies, making them vulnerable to developing shingles.
Each year, an estimated 3 to 5 out of every 1,000 people in Hong Kong will contract shingles, while the U.S. Centers for Disease Control and Prevention (CDC) estimates that one in three people in the U.S. will experience shingles during their lifetime.
Symptoms and Pain
Shingles is notorious for the intense pain it causes. The rash typically appears as clusters of blisters that may be localized to one area of the body, often on the torso or face. The pain is a result of inflammation in the nerve cells beneath the skin. For many sufferers, the pain is unlike any other, often described as a burning or electric shock sensation.
Sara, a woman in her fifties and a mother of three, shared her personal experience with shingles. “The pain went to a whole different level,” she recalled. Initially, Sara mistook the discomfort for liver pain, but by the second day, a rash had developed, and the pain intensified to a burning, electric-like sensation. By day four, after applying calamine lotion and taking pain medication, the blisters began to dry up, though the pain lingered for several more days.
The pain often becomes more intense at night due to hormone fluctuations, making it even more difficult to manage.
Risk Factors and Complications
While anyone who has had chickenpox is susceptible to shingles, the risk increases with age, particularly after the age of 50. In fact, up to 50% of shingles cases occur in people over the age of 60. Additionally, a weakened immune system, often due to factors like stress or other health conditions, can increase the likelihood of developing shingles.
Shingles can also lead to long-term complications. The most common is postherpetic neuralgia (PHN), a form of chronic nerve pain that affects 10 to 18% of those who experience shingles, with the risk rising significantly with age. Vision problems are another serious complication, especially if the virus affects the eyes, potentially leading to vision loss in 10 to 20% of cases. In rare instances, shingles can cause neurological issues, such as meningitis or encephalitis.
Additionally, shingles can recur, leading to a higher risk of further complications, including stroke. If the virus affects the facial nerve near the ear, it can lead to Ramsay Hunt syndrome, which causes facial paralysis and hearing loss.
Prevention and Vaccination
The good news is that shingles can be prevented with vaccination. The Shingrix vaccine, which has proven to be 97% effective in preventing shingles in adults aged 50 to 69, offers robust protection. For individuals aged 70 and older, the vaccine remains about 90% effective. The Shingrix vaccine is administered in two doses, spaced two to six months apart. It is recommended even for those who have previously had shingles or chickenpox, and it is safe for those who have received earlier versions of the vaccine, such as Zostavax, which was less effective in older adults.
Despite its effectiveness, the Shingrix vaccine is not universally accessible in some regions. In Hong Kong, a single course of the vaccine costs around HK$4,000 (approximately US$514). Dr. Wong Sze-man from Marina Medical in Hong Kong notes that the high cost, coupled with a general lack of awareness about the risks of shingles, prevents many people from getting vaccinated. Many individuals mistakenly believe that shingles is merely a nuisance rather than a serious health issue.
Other Treatment Options
While there is no cure for shingles, treatment can help manage symptoms and reduce the risk of complications. Antiviral medications, such as acyclovir, valacyclovir, and famciclovir, are often prescribed to speed up the healing process. Pain management is critical, and medications like gabapentin, which is typically used for nerve pain, are commonly recommended. Topical treatments, including lidocaine cream, calamine lotion, and cool compresses, can help soothe the skin and reduce discomfort.
Traditional Chinese Medicine (TCM) also offers alternative remedies for shingles. Acupuncture, electroacupuncture, and cupping therapy are used to stimulate the immune system and alleviate pain, particularly in cases where the shingles rash is located on the face or near the eyes.
The Link to Brain Health
New research has revealed an unexpected benefit of the Shingrix vaccine: a potential reduction in the risk of dementia. Studies suggest that people who received the vaccine have a 17% higher chance of remaining dementia-free for six years after vaccination, equating to an additional 164 days without a dementia diagnosis.
Conclusion
Shingles is more than just an uncomfortable rash. It can lead to severe pain, long-term complications, and even permanent disability. Vaccination remains the most effective way to prevent this condition, and the Shingrix vaccine offers hope for reducing both the incidence and severity of shingles. By raising awareness and promoting the importance of vaccination, we can better protect vulnerable populations and improve public health outcomes.
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