NoIt’s not just a dermatological problem and it doesn’t just concern “elderly people”. Shingles, also known as St. Anthony’s Fireit is not a rare or trivial disease, especially after the age of 50. In fact, as we age, the immune system loses part of its effectiveness and becomes less capable of keeping viruses under control that remain silent in the body for years. This is precisely the case with Varicella-Zoste virusr, responsible for both chickenpox and herpes zoster. The pain can be intense, prolonged and in some cases leave consequences that affect the quality of life. This is why vaccination is today considered a key prevention tool. To better understand why, when and for whom it is indicated, we asked for further information DoctorLuca Piromalligeneral practitioner in Milan.
Herpes zoster, commonly known as Shingles, is a disease caused by reactivation of the Varicella-Zoster virusthe same one that causes chickenpox. After primary infection (usually in childhood), the virus remains latent in the nerve ganglia and can reactivate even decades later.
After the age of 50 the risk increases significantly because the immune system undergoes a natural decline (immunosenescence); the ability to control the latent virus therefore decreases and both the frequency of the disease and the severity of complications increase.
Who is most exposed to the risk of developing complications?
Complications are more frequent in people over 50 for the reasons mentioned above, in immunocompromised subjects (for oncological diseases, transplants, immunosuppressive therapies or prolonged corticosteroids, HIV) and in people with chronic diseases (diabetes, COPD, renal failure, heart disease).
Particular attention should also be paid to subjects who have already had an episode of Zoster, especially if particularly severe or localized in risk areas (face or eye). In the latter case we speak of Ophthalmic zoster.
The most feared complication is the post-herpetic neuralgiaa chronic pain that can last months or years and seriously compromise the quality of life.
Why get vaccinated: benefits and prevention
The main benefits are:
significant reduction in the risk of developing herpes zoster
marked reduction in severe forms, complications, in particular post-herpetic neuralgia, and relapses
lower impact on chronic pain, disability and consumption of analgesic drugs.
The currently recommended vaccine is non-live recombinant adjuvanted: therefore it is no longer live attenuated and has a very high safety profile. The most common side effects are mild and transient (pain at the injection site, low-grade fever, tiredness). The administration takes place in 2 different doses 2-6 months apart.
In essence, i The benefits largely outweigh the risks, especially after age 50.
How does the vaccine reduce the likelihood of developing severe forms and complications such as post-herpetic neuralgia?
The vaccine strengthens the specific immune response against the Varicella-Zoster virus stimulating the production of T lymphocytes and antibodies which recognize and neutralize the virus in case of reactivation. Clinical studies demonstrate a greater than 90% reduction in the risk of post-herpetic neuralgia in vaccinated subjects.
To whom vaccination is recommended
At the moment there is vaccination in Italy recommended for all adults over 65 years of ageor from 18 years old for all those, as I said before, who suffer from chronic diseases (diabetes, COPD, kidney failure and heart disease) or conditions immunocompromise (oncological diseases, transplants, immunosuppressive therapies or prolonged use corticosteroids, HIV). The health authorities recommend it because theHerpes zoster is very frequent and underestimated; the incidence is approx 6 cases per 1000 inhabitants per year and complications have a strong health and social impact. It goes without saying that vaccination represents an effective tool for primary and secondary prevention.
Special conditions and frequent doubts
Can those who suffer from rashes, dermatitis or other skin conditions get vaccinated?
Yes. Erythema, dermatitis, psoriasis or other skin pathologies do not represent a contraindication, except for acute skin infections at the injection site or major flare-ups that require medical evaluation. In these cases it is sufficient to temporarily postpone vaccination.
Does the presence of recurrent cold sores affect eligibility for vaccination?
No. Cold sores are caused by a different virus (Herpes simplex) and does not represent a contraindication to vaccination against herpes zoster. Even recurrent episodes of cold sores do not affect the effectiveness or safety of the vaccine.
Should people who have had chickenpox in the past get vaccinated against shingles?
Yes, absolutely. Indeed, it is highly recommended and recommended as it reduces the risk of recurrence.
What are the main contraindications to vaccination?
The main contraindications are few:
They are not contraindications and in fact I would say indications for administration:
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