Healthy Choices

Shingles cases on the rise in Sacramento and nationwide despite vaccine

Sandy Fanning had walked past the signs advertising shingles vaccinations outside her neighborhood Rite Aid for months, but she wasn’t concerned about getting shingles herself.

The vaccine is marketed for people 60 years and older. Fanning is 57, so it came as a surprise when she was diagnosed with shingles last week after enduring a weekend of fatigue, aches, pains and itchiness caused by the virus.

“I didn’t associate shingles with what was happening to me,” said Fanning, who lives in Citrus Heights. “I didn’t put two and two together.”

The shingles vaccine, introduced in 2006, has failed to halt a steady rise in U.S. cases of the virus, also known as herpes zoster, since the early 1990s, said Dr. Ben Balatbat, an infectious-disease specialist and chairman of the Internal Medicine Department at Mercy Medical Group.

Infections have been increasing for people in most age groups, not just the most vulnerable populations, those over 60 or with weakened immune systems, said Dr. Rafael Harpaz, medical epidemiologist at the federal Centers for Disease Control and Prevention’s viral disease division.

“There’s a rise, but nobody knows why,” said Dr. Richard DeFelice, medical director of infection control at Sutter Health Sacramento.

Shingles occurs only in people who have already had chickenpox, or less commonly, people who have had the chickenpox vaccine, according to the CDC. Unlike chickenpox, people can get shingles more than once. All chickenpox and shingles cases are caused by the varicella zoster virus.

“You won’t get it for many years, but in the future our immune system weakens and then shingles will attack your nerves in the area where it has been dormant,” Balatbat said.

While not generally life-threatening, shingles can be excruciatingly painful. “The major problem is that there can be severe pain that lasts a long time,” DeFelice said.

The shingles vaccine cuts the risk of developing the illness in half and reduces the likelihood of complications, but most people don’t receive it, according to the CDC. The vaccine – a stronger version of the one administered to prevent chickenpox – is expensive and often not covered by insurance, Balatbat said. Pharmacies surveyed in the Sacramento area said they sell it for $200 to $250 a dose.

The U.S. Food and Drug Administration has approved the vaccine for people 50 and older. But because the CDC recommends the vaccine only for people older than 60, many insurance companies do not cover it for younger people, according to the CDC website.

Even for patients over 60, insurance programs do not necessarily cover the full cost of the shot, and it is not covered by Medicare Part B, according to Medicare Part D, which requires payment of additional premiums, does cover the vaccine. Overall, about one in five people over age 60 has gotten the vaccine, the CDC reports.

The pain of shingles is hard to describe and can’t be compared to another illness, Fanning said. The constant ache “that won’t go away” travels across her middle back along the ribs to her abdomen, just like the rash does.

The rash usually appears in a band, a strip or a small area on one side of the body or face, DeFelice said. It typically lasts for about a week when treated with an antiviral drug, but there is a complication called postherpetic neuralgia, or PHN, which refers to nerve pain that lasts after the illness, DeFelice said. Depending on the person, PHN can linger for weeks, months or years.

The illness tends to be more severe in older people, including a higher risk of PHN and other complications, such as infections of the rash area and nerve damage, Balatbat said.

Ethel Turner, 99, of Fair Oaks still suffers from PHN pain today – three years after having shingles on her backside, she said. Turner’s physician said she may have this pain for the rest of her life, said her niece Sharilyn Magana, 55, of Fair Oaks.

“The shingles haven’t come back, but the pain has never left,” Turner said.

Turner had shingles when she was 96, and was bedridden for more than two weeks. She has dime-sized scars where the quarter-sized shingles blisters broke, Magana said. The pain lingers near those scars.

About one-third of all people will eventually get shingles, with roughly half of the cases in people who are over the age of 60, the CDC reports. A stronger immune response helps keep the virus contained, but young and healthy people can still get it.

While someone with shingles can’t pass it on, contact with the rash can transfer the virus – potentially giving someone chickenpox if they haven’t already had it.

The rate of shingles is increasing for all age groups except one: young people, who have generally been vaccinated against chickenpox, according to a study by Harpaz and colleagues. People 17 and younger who have had the chickenpox vaccine are nearly five times less likely to get shingles than those who had chickenpox, according to a separate study in the Journal of Infectious Diseases. Because the chickenpox vaccine has only been available for 19 years, it will be many years before researchers know if it also protects people from shingles as they age.

Some experts have suggested the chickenpox vaccine, introduced in 1995, could be to blame for the overall rise in shingles cases, DeFelice said. The idea is that adults previously got an immunity boost when they encountered young people with the chickenpox virus. As the number of children with chickenpox decreased, the theory goes, fewer adults got this boost, causing more of them to get shingles.

But the CDC debunked that theory, DeFelice said. The increase in shingles cases began prior to the introduction of the chickenpox vaccine and continued afterward. A similar increase also has been seen in some countries in Asia and Europe that introduced the chickenpox vaccine at other times, Harpaz said.

Harpaz said he doesn’t know why shingles rates are increasing, but expects it’s connected to the still unknown factors that cause some people to get shingles while others don’t.

“The mystery is hiding pretty well,” he said.