By the way, doctor: Should I get the shingles vaccine?
Q. I'm 79 and had chickenpox as a child. Should I get the shingles vaccine? What are the risks?
A. The U.S. Advisory Committee on Immunization Practices (ACIP) recommends the shingles vaccine for most people ages 60 and over, regardless of whether they recall having had the chickenpox or not. (Studies show that 99% of people over age 40 have had chickenpox.) Shingles, also called herpes zoster, or zoster, is a painful blistering rash caused by the same virus that causes chickenpox — the varicella zoster virus (VZV). After you recover from chickenpox, VZV retreats to nerve cells near the spine, where it lies dormant until it comes to life again as shingles. About one in three people will develop shingles during her or his lifetime. It occurs most often in older adults and in people whose immune systems have been weakened by chronic infections, cancer, or immune-suppressing drugs, such as steroids or chemotherapy.
When VZV is reactivated, it moves away from the spine and travels along nerve pathways that provide the sensory network for specific skin areas called dermatomes, which are arranged in a band-like pattern radiating from the spine. The shingles rash — small fluid-filled blisters resembling chickenpox — breaks out along dermatome lines on one side of the face or body (see the illustration). It can range from simply itchy and uncomfortable to extremely painful, and it may be accompanied by fever, headache, and nausea. The rash crusts over after seven to 10 days, and is usually gone within a few weeks. In about 20% of cases, the pain lingers after the rash has disappeared; this sometimes debilitating condition is called postherpetic neuralgia.