The herpes zoster virus, which causes shingles, is becoming more common as the population ages. In Australia the number of cases has doubled between 2000 and 2010. Hospital emergency departments report a 2–6% increase in cases per year.
Writing in the October edition of Australian Prescriber, Professor Dominic Dwyer and Dr Michael Wehrhahn, infectious diseases specialists at Sydney’s Westmead Hospital, say the recent rise in shingles cases is probably due to a number of factors, and urged more widespread uptake of the herpes zoster vaccine in adults.
“Shingles commonly presents as a painful blistering skin rash on the abdomen,” write the authors. “It is more common in people over the age of 60, so as our population ages we are likely to see more of it. Evidence also shows that recurrent attacks of the virus are more common than previously believed.
“Other reasons for a rise in prevalence are thought to be the increased use of immunosuppressant drugs – making people more susceptible to the virus – and the widespread use of the chickenpox vaccination in children.” (Shingles is caused by the same virus as chickenpox.)
It is thought that because there is now less chickenpox in children, older people are not boosting their immunity to the virus and so may be more susceptible to shingles later in life.
The herpes zoster vaccine, available in Australia and recommended for people over the age of 60 since 2009, has been shown to reduce the prevalence of the virus as well as its associated complications. The vaccine can also be considered for younger adults, depending on their clinical circumstances. It should not, however, be given to people with significant immune impairment, such as those on high-dose steroids, some patients with HIV and pregnant women.
If a person is diagnosed with shingles, an antiviral medicine given within 72 hours of the onset of the rash can reduce the severity and duration of the illness.
“It is also important to treat any pain associated with shingles as early as possible. This can reduce the severity and likelihood of complications, such as prolonged pain,” write the authors.
Although shingles is less contagious than chickenpox, recent research has found the virus in human saliva, meaning it could be more contagious than previously thought. People with the virus should therefore avoid contact with people who may be susceptible, especially pregnant women and people with low immunity.