Shingles May Cause Long-Term Pain In Older People – Expert

As Malaysia undergoes a demographic shift towards an ageing population, growing attention is being drawn to the potential health implications for the elderly.

As individuals age, their immune systems tend to weaken, rendering them more vulnerable to various diseases, one of which is shingles, also known as herpes zoster (HZ).

Shingles presents significant health risks for older adults, often leading to disabling complications, with recovery in these vulnerable populations frequently being prolonged.

Shingles is a skin condition caused by the reactivation of the varicella-zoster virus (VZV), the same virus responsible for chickenpox. (The virus remains dormant in some nerve cells after an individual recovers from chickenpox. When it becomes activated, the result is shingles.)

This reactivation is more common among older adults (50 years old and above) or individuals with compromised immune systems.

INCREASE IN CASES

Dr Peter Ch'ng, a consultant dermatologist at Gleneagles Hospital Kuala Lumpur and honorary secretary of the Dermatological Society of Malaysia, said shingles typically manifests as a rash with painful blisters on areas such as the chest, abdomen or face.

The rash and blisters may lead to itching, sensitivity and potentially secondary bacterial infections. On the McGill Pain Scale, shingles-related pain is often described as more severe than labour pain or post-surgical pain.

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According to Dr Ch’ng, there has been a noticeable increase in the number of shingles cases treated at his workplace, particularly following the COVID-19 pandemic.

It is speculated that the reduced physical activity levels during the pandemic may have contributed to the resurgence of VZV infections, leading to an uptick in shingles cases, he said.

On the health complications faced by elderly people who contract shingles, Dr Ch’ng told Bernama recent medical studies have demonstrated a correlation between the incidence of postherpetic neuralgia (PHN) and advancing age.

PHN is characterised by pain lasting from three months to several years after the rash subsides, and it is also the most common complication of shingles and can affect 10 to 20 percent of all shingles cases, varying based on age.

A recent study published in an international health blog link.springer.com on March 17 stated that approximately 10.2 million cases of shingles could occur during the remaining lifetimes of people aged 50 years and above in Indonesia, Malaysia, Philippines, Thailand and Vietnam, “with many cases resulting in serious, painful complications including PHN (2.1 million cases).”

Dr Ch’ng also said another specific manifestation of shingles that warrants attention is herpes zoster ophthalmicus (HZO). HZO affects the eye and is observed in up to 25 percent of shingles patients, with the potential, in rare cases, to lead to vision loss.

A characteristic feature of HZO is the appearance of a rash on the forehead, scalp and sometimes on the nose, commonly referred to as Hutchinson’s sign. This rash can progress to form painful blisters, and even after the rash has resolved, the discomfort may persist.

“When the infection involves the deeper structures of the eye, it can result in vision abnormalities or even permanent vision loss. Therefore, prompt medical attention and guidance from an ophthalmologist is essential when dealing with shingles cases that impact the eyes of patients,” he added.

NEW VACCINE

While shingles can resolve on its own without treatment, the condition should be treated with antiviral medication as soon as it is diagnosed to prevent complications. Painkillers are also prescribed to relieve pain caused by the rash.

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Dr Ch’ng said dealing with shingles can be challenging for both patients and their caregivers. From the patients’ perspective, he said, the intense, burning pain in their nerves can be debilitating and affect their daily activities and overall well-being, even after the rashes have healed.

This is because the pain and itching can disrupt one’s sleep, leading to fatigue and further affecting their quality of life. Depending on where the rash appears, it may interfere with normal activities such as walking or using the arms, causing functional limitations.

“This not only affects the patients but also puts a significant burden on their caregivers, who may find it physically and emotionally demanding to provide care and support,” he said.

Meanwhile, GlaxoSmithKline Pharmaceutical Sdn Bhd (GSK), a global biopharma company, recently launched a new vaccine called Shingrix to prevent shingles. Shingrix is also known as Recombinant Zoster Vaccine, Adjuvanted (RZV).

GSK country medical director Dr Alap Gandhi said the vaccine is designed to prevent shingles and PHN in adults aged 50 and above, as well as in adults aged 18 and above who are at an increased risk of contracting shingles.

“RZV combines a non-live antigen with GSK’s adjuvant AS01B and glycoprotein E to help address the decline in immunity as people age. The vaccine is administered in two doses, given two to six months apart,” he said, adding the vaccine is currently available in Malaysia.

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He said some common post-injection side effects of RZV are mild to moderate pain at the injection site, fatigue and headache, which typically resolve within three days.

He said GSK’s analysis of recent pivotal efficacy studies, which involved 30,000 participants from 18 countries including Japan and Taiwan, demonstrated that RZV has a vaccine efficacy of up to 97 percent in adults aged 50 and above over a follow-up period of approximately three years.

Recent interim data also showed overall vaccine efficacy of greater than 80 percent approximately six to 10 years after initial vaccination in people aged 50 and above.

“We are also pleased to announce the Malaysian Society of Infectious Diseases and Chemotherapy has also recommended the shingles vaccine in its 2023 Guidelines for Adult Immunisation,” he added.