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The Importance of Immunizations for all Ages

National Immunization Awareness Month (NIAM) is an annual observance held in August to highlight the importance of vaccinations for people of all ages. Immunizations are essential for infants and children, pre-teens and teens, and yes – Adults Too! Please refer to the vaccine schedule web links below for recommendations for each age group.

An illustration of a virusHerpes zoster, also known as zoster and shingles, is one disease to highlight that can be prevented, or complications lessened, through vaccination. It is caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays dormant (latent) in the sensory ganglia (a part of the nervous system). VZV can reactivate later in a person's life, and cause a painful rash called herpes zoster or shingles.

A person can also get shingles if vaccinated for chickenpox, with the varicella vaccine. The varicella vaccine contains live attenuated VZV, which also causes latent infection that can be reactivated. However, children vaccinated with varicella appear to have a lower risk of herpes zoster than people who were infected with wild-type VZV. The reason for this is that vaccinated children are less likely to become infected with wild-type VZV, and the risk of reactivation of vaccine-strain VZV is lower compared with reactivation of wild-type VZV.

Almost 1 out of 3 people in the United States will develop shingles during their lifetime. People with weaker immune systems related to certain chronic conditions or medications are at greater risk, as well as an increase of age, especially after age 50. Most people who get shingles will have it only once. However, it is possible to get it a second or even third time. The most common complication of shingles is post-herpetic neuralgia (PHN), which is severe pain in the area(s) where the shingles rash occurred. About 1 out of 5 people with shingles will get PHN. The risk of PHN increases with age.

If not vaccinated, a person should be aware of signs and symptoms. Shingles is a painful rash that develops on one side of the face or body. The rash forms blisters that typically scab over in 7 to 10 days and clears up within 2 to 4 weeks. Before the rash develops, people often have pain, itching, or tingling in the area where the rash will develop. This may happen anywhere from 1 to 5 days before the rash appears. Several antiviral medicines—acyclovir, valacyclovir, and famciclovir—are available to treat shingles. These medicines will help shorten the length and severity of the illness. To be effective, they must be started as soon as possible. Pain relief medication is also used, as the pain with shingles can be severe.

My story: A not-so-typical case of shingles at age 45.

One Saturday evening I felt pain in my right eye, deep in the eye socket. We had cleared snow for several hours, so I thought I had strained my eye. It gradually got worse over the next three days. On day four I woke up not able to open my eye to light, as the pain was so severe. I was able to see the eye doctor that morning and with concern of a tumor, he sent me for a CT-scan. After that procedure, and seeing me in excruciating pain (I have a high tolerance of pain) my husband decided to take me to our primary care provider (PCP) to be seen, if possible. After explaining what I was experiencing and relaying my fear that it was shingles, my PCP saw me right away. Along with the pain, I had experienced a funny sensation around my right eyebrow and forehead the day before. I did not have any rash at all at this point, but my physician knew me, acknowledged my symptoms, and listened to my concerns, fears and speculations. He agreed and started the antiviral medication, mainly to lessen the chance of the post-herpetic neuralgia. I was also given Neurontin and pain medication for the nerve pain I was experiencing. The next 6 days are really a blur. I only remember waking up to take medication, moving from my bed to the recliner and back, and eating very little. My right forehead, brow area and into my scalp broke out in a rash and scabbed over, and my eye almost swelled shut. I did not want to see any anyone, talk to anyone, have light in my room or any stimulation around me. I was out of work for over 4 weeks.

I am about 5 months post shingles and I continue to have tingling and moderate pain around my eye, sometimes into my cheek area and forehead. Sometimes I have a burning pain or itching in my scalp area. I had my annual eye exam and my ophthalmologist said I had lesions on my cornea, which should disappear in the next 5 – 6 years. I will obtain the vaccine at 6 months, as I want to lessen any chance of ever having this again. Dana

The Advisory Committee on Immunization Practices (ACIP) recommends that adults aged 60 years or older receive 1 dose of zoster vaccine to help prevent the disease and its potentially debilitating complications, including post-herpetic neuralgia. Even people who have had herpes zoster should receive the vaccine to help prevent future occurrences of the disease. The shingles vaccine is approved by FDA for people aged 50 years and older. However, CDC does not have a recommendation for routine use of shingles vaccine in people aged 50 through 59 years old. Adults aged 50 through 59 years who have questions about the shingles vaccine should discuss the risks and benefits with a health care provider.

The unfortunate fact is that only 1 in 5 adults aged 60 years or older has received the zoster vaccine. Only 20% of the recommended age group is vaccinated to protect from the severe and possible long-term pain. Shingles is increasing among adults in the United States. The increase has been gradual over a long period of time. We do not know the reason for this increase. The best defense is to be vaccinated.

    Article provided by Dana Breeding, RN Health Educator with Community Outreach.