If you’re over the age of 25, chances are you had chicken pox (varicella zoster) as a child.
I myself remember the smell of calamine lotion dabbed onto my itching, blistered skin by my mother. I remember eating chicken noodle soup, snuggling up on the couch with my stuffed animals, and my protective older sister slapping my hands, telling me to “Stop picking!” Despite her best intentions, I now have three chicken pox scars (I’d pick when she wasn’t looking).
In a way, getting chicken pox was a rite of passage.
But I realize that in admitting this that I’m outing myself as being “old.” It seems like nobody gets infected with natural chicken pox anymore; the “kids” these days are taking the vaccine instead.
But what does that have to do with SHINGLES? Read on.
Chicken Pox (Disease or Vaccine) Can Lead to Shingles
Although we often talk about “getting over” chicken pox, the truth is the virus never really leaves the body. Even after the small blisters (known as vesicles) are gone, the varicella zoster virus lives on in the nervous system in a part of the nerves known as the dorsal root ganglion. Usually, it lies dormant and causes no problems. But sometimes the chicken pox virus can become reactivated, causing another illness known as shingles.
Shingles – also known as Herpes Zoster (HZ) and Human Herpes Virus Type 3 (HHV3) – can affect anybody who’s had chicken pox and anybody who’s had the varicella vaccine.
Unlike chicken pox, which causes blisters on many different parts of the body simultaneously, shingles lesions tend to affect just one or two areas (known as a dermatomes). In addition to being itchy, the blister-like lesions that crop up with shingles can be quite painful, and that pain can become chronic in a condition known as post-herpetic neuralgia.
It is also possible to get shingles more than once, as the virus is always in the nervous system and can become reactivated at any time.
As with chicken pox, the blisters can result in scarring or in changes in skin pigmentation. Until the blisters dry and crust over (which takes 2-4 weeks), shingles is also contagious. But that’s not likely why we’re seeing more cases of it in America these days.
Shingles is on the Rise – Perhaps Because of the Chicken Pox Vaccine
Many immunologists agree that we’re seeing more cases of shingles in America because nobody gets natural chicken pox anymore. I know, this seems counter-intuitive at first pass. But think of it this way…
Before the chicken pox (varicella) vaccine became commercially available in 1995, the majority of American children got chicken pox at one point or another. That meant that most American adults (1) had had natural chicken pox themselves at some point, and (2) that they were constantly exposed to low levels of the varicella virus. Even if they themselves didn’t have a kid with chicken pox, maybe their neighbor did, or a co-worker, or another family at church. Because American adults were always getting a little exposure here and a little exposure there, their immune systems were always primed to fight varicella zoster.
So, what’s happened over the last 20 years? Most American kids don’t get natural chicken pox infections, taking the vaccine instead. Adults in turn don’t get their little “homeopathic” doses of varicella exposure anymore. This could very well be why more and more of us are getting shingles.
The population at greatest risk for shingles is the elderly, as a result of a decrease in immunity with age. As more and more children get inoculated against chicken pox, however, there’s been a rise in the number of shingles cases among adults and even college students. Yikes!
To Recap: You Don’t Want to Get Shingles Because:
It can be quite painful
You can get it more than once
It can become chronic, leading to long-term pain and/or scarring of the skin
It’s on the rise – likely because of the chicken pox vaccine
For these reasons, I typically recommend the shingles vaccines to most of my patients at around age 50. Unlike other illnesses that keep you in bed for a week and then let you move on with your life, shingles can keep coming back, and can cause chronic pain.
This is but one example of how one medical intervention necessitates another, and how nothing happens in a vacuum. In our altruistic intention of sparring children the discomfort of chicken pox (a relatively benign, self-limiting disease), have we placed our elders at increased risk for a more serious condition? Quite possibly.
Goldman GS, King PG, Myers MG. Vaccination to prevent varicella. Vaccine 2013, Mar 25;31(13):1680-94.
Welsby PD. Chickenpox, chickenpox vaccination, and shingles. Postgrad Med J 2006, May;82(967):351-2.
Brisson M, Gay NJ, Edmunds WJ, Andrews NJ. Exposure to varicella boosts immunity to herpes-zoster: Implications for mass vaccination against chickenpox. Vaccine 2002;20(19):2500-7.
Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Atkinson W, Hamborsky J, Wolfe S, eds. 12th ed., second printing. Washington DC: Public Health Foundation, 2012
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