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Herpes zoster: ten things to know about shingles

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Herpes zoster: ten things to know about shingles

At least two out of 10 people don’t know what shingles is and one in two says they know little. Yet, nearly two in three know others who have suffered from it, and 12% have actually had it. These are some of the data that emerged from a global survey promoted by GSK on the occasion of the Shingles awareness weekinternational awareness week onHerpes zoster (February 26 – March 3), a campaign conducted in collaboration with the International Federation on Aging (Ifa) with the aim of raising awareness and addressing the lack of knowledge about the risks and impact of Herpes zoster.

The online survey interviewed 3,500 adults aged 50 and over from 12 countries (China, United States, Germany, Brazil, Japan, United Kingdom, Australia, Italy, South Korea, India, Canada and Portugal), assessing respondents’ understanding of shingles, what can trigger it and its impact on people’s lives. Worryingly, new data suggests that many adults aged 50 and older misunderstand important aspects of the disease, including how it can develop and the complications that can arise in the frailest people. Here are ten answers to learn more about this virus and understand how to prevent it.

What is Herpes Zoster?

Herpes Zoster, more commonly known as Shingles, is the reactivation of the varicella zoster virus that affects nervous structures. When questioned on this point, Italians are approved with reservations: the painful skin rash is the key sign for 76% of those interviewed, for 63% it is also itchy. 38% speak generically of nerve pain.

“Usually, when the virus reactivates – he explains Francesco Vitale, professor of Hygiene and preventive medicine at the University of Palermo – is associated with a painful skin rash which, although it can appear in any part of the body, appears more frequently on only one side of the chest or abdomen in the form of a single strip of vesicles. The varicella zoster virus belongs to the large herpes virus family and is the same one that causes chickenpox in children.”

The virus, in fact, after causing chickenpox, remains inactive in the nervous tissue and then reawakens, many years later, in the form of shingles. Approximately one in three adults is at risk of developing an episode of Herpes Zoster during their lifetime. The incidence and severity increase with age with an increase after the age of 50, reaching one in two individuals in subjects over the age of 85.

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How does Herpes Zoster manifest itself?

When the virus reactivates, it causes pain, burning, tingling, or itching. Generally, these symptoms appear on one part of the body and are among the first signs of shingles rash. Often, these symptoms precede the appearance of the rash by a few days.

“After the initial symptoms – explains Vitale – a skin rash appears that develops into fluid-filled blisters. These blisters rupture, forming small ulcers that begin to dry out and form crusts within 7-10 days.” The shingles rash usually clears up within 2 to 4 weeks. However, pain may persist for a longer period, especially in older adults.

How many people does it affect?

Unfortunately there are no official data on the exact number of people who get herpes zoster, but it is estimated that there are 150 thousand new diagnoses per year. In most cases, these are patients who are treated directly by the general practitioner. But sometimes the situation is more serious: “In 15 years in Italy, over 74 thousand hospitalizations for Herpes zoster have been recorded, of which 30,891 as the main diagnosis and more than 43 thousand as a secondary diagnosis”, Vitale specifies.

Who are the subjects most at risk?

Some people are more at risk of developing Herpes zoster or one of its complications. In particular, the elderly and those who have a weaker immune system: “From fifty years of age onwards a process of immuno-senescence begins which makes us more vulnerable to infections, but all those who have to take therapies which determine immunosuppression such as those suffering from a rheumatic or gastroenterological disease such as Crohn’s disease and ulcerative colitis, from a tumor or a chronic-degenerative disease”, replies Vitale who is keen to underline that anxiety and stress must also be considered risk factors.

According to a recent study conducted in Denmark on 77 thousand people and published in the British Journal of Dermatology, in fact, those who live in a condition of psychological stress have a twice greater risk of developing an episode of Herpes Zoster.

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Is Zoster dangerous for your health?

Shingles is considered a very remote health risk. Only 10% of those interviewed consider it very likely to develop it in their lifetime. More than one in three people (36%) think it is somewhat or completely unlikely.

But even if in most cases it heals without problems, for some people Herpes zoster can be dangerous: “For anyone affected by it – explains Vitale – there is a fairly strong impact on the quality of life that it can generate in some cases a certain depression both due to the constant pain and the sensation of feeling impaired. Furthermore, depending on the nerve that is intercepted by the virus, there may be greater damage. For example, if the optic nerve is affected, one may even suffer to blindness.”

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In 30% of cases, then, a rather annoying complication can occur which is post-herpetic neuropathy which causes very severe pain at the level of the nerve involved, which lasts for at least 90 days after the skin rash; the duration of post-herpetic neuralgia varies from a few months to years or even for a lifetime with a negative and disabling impact on the patient’s quality of life.

How is it treated?

For the treatment of Herpes zoster, local and/or general (systemic) treatments can be used to reduce symptoms and limit the risk of complications. Treatments include: antivirals, specific drugs that block the reproduction (replication) of the virus, reducing the duration of the disease, but which do not act on pain; painkillers and anti-inflammatories; gel based on aluminum chloride, applied directly to the blisters, accelerates healing and reduces itching/pain.

Is Shingles contagious?

55% of those interviewed believe that “you can get shingles from someone who has it”. It’s really like this? “Herpes zoster cannot be transmitted from person to person like other airborne diseases such as Covid-19 and cannot be transmitted through coughing or sneezing”, replies Vitale who clarifies: “The contagion, however, can occurs through direct contact with the fluid from the rash blisters of a person with Herpes zoster. Once the blisters have dried and crusted over, the person is no longer contagious.”

To reduce the risk of infection, people with shingles should keep the area of ​​the rash covered and avoid direct contact with infants, pregnant women, and people with weakened immune systems until all the blisters clear up. they are dried and crusted.

Does Zoster live inside us?

One in two people think that zoster is a virus that most people already have in their nervous systems. Is that so? “In fact – replies Vitale – we can say that it lives inside us from the moment we contract chickenpox as children because even when we recover the virus actually goes to ‘asleep’ in the cells of the dorsal ganglia of the spinal column and at a certain moment of life will be able to reawaken where the immune defenses weaken”.

Therefore, we live with a virus that remains latent: “It’s a bit like cold sores that manifest themselves in stressful conditions, for example, when there is an exam to take, when there is the flu or menstruation. for women. Once that phase is over, the bubbles on the lip disappear and it seems that we are healed, but in reality the virus remains inside us but silent.”

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Is prevention possible?

Prevention of Herpes zoster infection can be conducted through the vaccine which has been available for several years in Italy and is provided for in the new National Vaccine Prevention Plan included in the Essential Levels of Assistance.

The vaccine – emerges from the survey – is considered a valid prevention method for 62% of those interviewed, but 30% are unaware of its availability and for 8 out of 10 people, shingles is not preventable. In any case, with an apparent dissonance, 76% of those interviewed think that getting vaccinated is the best way to prevent the virus.

“The vaccination for Herpes zoster guarantees coverage for approximately 10 years, is free and recommended in people over 65 years of age or in individuals at risk, even if younger. A new recombinant vaccine is now available in Italy, not containing live virus, to be administered intramuscularly and recommended in all categories for which the anti-Herpes Zoster vaccination is indicated”.

The efficacy of the adjuvanted recombinant vaccine achieved results above 90% in all age groups over fifty years. “But it is essential – reiterates the doctor – that the adult population and in particular fragile and at-risk subjects turn to their trusted doctor for guidance on how to recognise, understand and reduce the risk of developing this debilitating disease”.

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Are there lifestyles that help protect us?

47% of those interviewed think it is essential to have a healthy and balanced diet, 36% do physical exercise every week, 48% have good personal hygiene, 31% think it is important to reduce the level of stress. How are things? “Healthy lifestyles, that is, eating in a balanced way, not being overweight, not smoking, not drinking too much alcohol, carrying out regular physical activity and easing stress – replies the doctor – contribute to keeping us in good health by protecting us from infections in general and therefore also from Herpes zoster”.

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