Dennis Bowden remembers the pain he felt along his right jaw a couple of summers ago: it was bad enough to warrant a trip to the dentist. The dental expert couldn’t find anything to indicate an infection or other problem, though, so the 39-year-old landscaper went home, assuming the severe discomfort would go away.
Things got worse.
Flashes of pain became so severe that he sometimes had to brace himself against a counter.
“It was like an electric shock, these jolts of intense pain,” Bowden says. “It was the worst pain I’ve ever experienced in my life.”
Little spots began appearing beneath the stubble on one side of his face. At last, a doctor at a Vancouver walk-in clinic diagnosed him with shingles.
The viral illness is caused by the varicella-zoster virus, the same virus that causes chickenpox.
Bowden is one of 130,000 Canadians who has shingles every year.
What has researchers perplexed is that the incidence of cases has been increasing among adults for years. According to the U.S. Centers for Disease Control, rates went up by 39 per cent from 1992 to 2010.
The reason for the rise remains a mystery.
One theory held that the rise is related to fewer chickenpox cases in children due to widespread vaccination against the childhood illness, which is caused by the same virus, varicella-zoster. The thinking was that chickenpox would boost a person’s immunity to the virus, so as a result, fewer people with chickenpox could theoretically lead to an increase in shingles in adults.
However, this possible explanation has been debunked by the CDC. Studies have found that shingles rates started increasing before the chickenpox vaccine was introduced in the United States.
Plus, other countries without routine chickenpox vaccination programs have observed similar rising rates of shingles.
“If nothing else, the aging population is driving it,” says Dr. John Murray, an emergency physician in Ontario and B.C. “With people living longer, it’s not a surprise we’re going to get more cases. It tends to attack older people simply because they have more immunocompromised immune systems, and many are being treated with steroids and prednisone, which weaken the immune system.”
What is clear is that the illness can be dreadful.
After you’ve had chickenpox, the virus lies dormant in nerve tissue near your spinal cord and brain. Years or decades later, the virus may reactivate as shingles, affecting the area of the body along the nerve where it had been residing. Initial symptoms include tingling, burning, or itching sensation on the skin. Some people develop a fever, headache, or malaise. Within a few days, a rash appears on one side of the body only.
“The virus travels along the nerve root, and any given nerve supplies an area of the skin,” Murray explains, referring to an area known as a dermatome. “Pain can occur before the rash appears. Most people ignore that, but by the time they get the rash, that’s when they come in. It often wraps around the back or shoulder blade in a band-like pattern, and it doesn’t cross the midline. Then the rash turns into blisters filled with fluid that get really crusty.
“It’s usually on the trunk, but if the virus is in the brain, it can affect the neck, jaw, teeth…” he adds. “Any dermatome can be affected.”
Complications can occur, too. Pain that lasts after the rash goes away is called postherpetic neuralgia, and it can last for months or even years. The eye can become inflamed, and damage to the retina can occur, even leading to permanent vision loss. Ear inflammation and blisters in the ear canal are other possibilities. And the blisters can become infected.
“The most common complication is secondary infection,” Murray says. “Any time there’s a break in your skin, you can get a secondary bacterial infection. People can get really sick—febrile and needing intravenous antibiotics.”
Shingles itself isn’t contagious, but if someone has never had chickenpox or the chickenpox vaccine, they can get chickenpox after direct, skin-to-skin contact with a shingles blister or by inhaling the virus.
Even though seniors are especially prone to shingles, Vancouver emergency doctor Michael Curry reminds that any adult can develop the illness, even people in their 20s and 30s. And although no hard proof exists, it seems associated with stress.
“I’ve had patients with shingles who are older and who have had a recent death in family, the loss of a spouse; they’re under emotional or psychological stress,” Curry says. “I’ve seen that many times. However it [shingles] begins we don’t fully understand, but we know that emotional or psychological stress has an impact on the physical health of the body as well.”
Antiviral medication is only effective if it’s started within 72 hours of illness onset; by the time a rash appears and someone gets to a doctor, it’s often too late. Antivirals don’t appear to affect the shingles outbreak itself, Curry says; rather, they can reduce the risk of long-term complications like postherpetic neuralgia.
Doctors recommend adults get vaccinated for shingles, beginning at age 50.
“Having had chickenpox, I know I’m definitely at risk of shingles,” Curry says. “Shingles is a terrible illness.”