Shingles is a widespread disease associated with severe, sometimes almost unbearable nerve pain. According to studies by the Robert Koch Institute (RKI), more than 300 cats fall ill with shingles in Germany every year.000 people about it. Vaccination offers effective protection against herpes zoster, as the disease is medically known. For older people, the statutory health insurance companies have recently begun to cover the costs. How does shingles develop, how is it treated and why is vaccination advisable?
From chickenpox to shingles
The disease is triggered by a virus called varicella-zoster. This virus leads – mainly in childhood – to chickenpox, and can later, as a subsequent secondary disease, cause shingles. Even when chickenpox is cured, varicella zoster viruses remain in the body. They hide in the ganglia, the nerve nodes along the spine. In times when the immune system is weakened for a longer period of time, for example during permanent stress, during a serious illness or in old age, there is a risk that the viruses become active again and spread along the spinal nerves. Because the spinal nerves, starting from the spine, run around the body in a belt shape, the characteristic course that gives the disease its name occurs: Shingles. Sometimes the viruses also affect one of the cranial nerves, which leads to very painful symptoms in the face. Then one speaks of a facial erysipelas.
First signs and symptoms of shingles
The first signs of shingles are fatigue, headache, aching limbs and a slight increase in temperature. Where the viruses spread, there is a dull or pulling pain. After three to five days, a rash with redness and purulent blisters, associated with a burning pain, forms along the nerve pathways. Also additional insensations, for example numbness, are possible in the affected area.
Mostly the viruses attack the trunk. If the face is affected – often along the so-called trigeminal nerve – painful burning and facial redness occur, especially in the area of the eyes and forehead. The facial nerve, another cranial nerve, can also be affected. In this case especially the ears hurt, sometimes also the tongue and palate.
Course and complications
Shingles usually disappears after two to four weeks. However, in people over 80 years of age, in about one in five it turns into a chronic pain condition called post-zoster neuralgia: here the pain continues for one to two years, even when the skin redness and pustules are no longer visible.
The pain, both with shingles and with post-zoster neuralgia, can become so unbearably bad that it can hardly be controlled with painkillers and has already driven people to suicide.
For a mild form of shingles, the doctor will prescribe a zinc paste that dries out the pustules and allows the inflammation to subside. For moderate and severe forms, a virus-inhibiting agent is administered, either in tablet form or as an infusion. This should prevent the worsening of shingles and shorten the duration of the disease. If the inner ear is affected, an antibiotic is also useful to prevent a secondary bacterial infection from forming.
Strong painkillers are usually given for the excruciating pain. With timely antiviral treatment, combined with sufficiently long pain management, the risk of later post-zoster neuralgia decreases.
Once shingles has been overcome, it can break out again and again. In fact, as people age, this becomes more likely because immune system activity declines. Since a few years, there is a new type of vaccine against the pathogens of shingles, which is especially helpful for the elderly and since March 2019 is paid by the statutory health insurance in Germany.
The new vaccine "Shingrix" contains a protein taken from the disease-causing varicella-zoster virus and combined with an auxiliary drug system. With the vaccination a natural immune response to the pathogen is evoked and strengthened. In this way, especially seniors should be protected from shingles and from post-zoster neuralgia. The effectiveness is 90 percent in all age groups.
The vaccination consists of two doses, which are administered intramuscularly at intervals of at least two to a maximum of six months. There is no evidence of serious side effects. However, redness and swelling of the skin at the vaccination site, as well as fever, fatigue, muscle aches and headaches, must be expected in the first two days.
The Standing Commission on Vaccination (STIKO) recommends this vaccination for people over 60 years of age. Since it is a so-called dead vaccine and the vaccination is therefore particularly well tolerated, it can be used effectively even with a weakened immune system, for example, as a result of HIV infection.
For people in whom the body’s own immune system is suppressed for therapeutic reasons (immunosuppression), as well as for certain underlying diseases such as rheumatoid arthritis, diabetes or COPD, vaccination is recommended from the age of 50. Talk to your doctor if the vaccination is an option for you. Thus, if necessary, you can protect yourself in time against a painful and debilitating disease.