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Shingles, a mutant variety of chickenpox, can cause many a complication and usually affects the elderly. It’s a painful secondary infection, born from a variation of what was once considered to be the most commonplace of childhood illnesses.

Before the varicella vaccine was introduced in India in 1999, chickenpox was considered a rather universal experience without any real threat to one’s health or well-being. However, an attack of the chickenpox isn’t as simple as it seems. It can have far-reaching consequences on your health.

“Regardless of when you contract chickenpox (either as an adult or a child), the Varicella Zoster Virus (VZV) that causes the disease can stay dormant in your body for years," says Sai Kishore, intensivist and pulmonologist at the KL Multispecialty Hospital and St Isabel’s Hospital in Chennai. “The virus is reactivated when you experience a period of weakened immunity. It’s like a dormant volcano that eventually erupts."

No one knows exactly why the virus is reactivated in the body, or even when this may occur. Chronic medical complaints such as diabetes, cancer and HIV can compromise immunity and possibly trigger an attack. “The reactivation of the varicella virus takes many years and can occur any time after a patient has had the chickenpox," says J. Prabhusankar, managing director and consultant geriatrician at the Sri Lingammal Nursing Home, Theni, Tamil Nadu. “For most people, the onset of old age (and the overall weakening of the immune system that accompanies it) is when they’re most vulnerable to shingles. Shingles can affect younger people as well, but such cases are rare."

The age group that is most affected is above 60, though those above 50 are at risk too, says Dr Prabhusankar. “This is because the risk almost doubles after this age. Anyone with a vulnerable immune system is at risk, not just the elderly. This would include cancer patients, organ transplant recipients, those under severe psychological stress and physical trauma."

The three phases

Shingles progresses in three phases, each with distinctive symptoms. “In the earliest pre-emptive phase, the patient will feel a sensation of itchiness and pain along the nerves," says Dr Kishore. “Your eye or throat might be infected, accompanied by increasing fatigue." A diagnosis at this stage is hard because pain is the predominant symptom.

The second phase is the eruptive phase, when crops of white boils filled with fluid erupt, often accompanied by high fever. Unlike the chickenpox, shingles rashes are restricted to one side of the body.

“The shingles virus lies dormant in the areas of your body where your nerves gather in a bundle—called multiple dorsal root ganglia. It’s usually found in the nerves of your spinal cord or in your cranium (skull)," says Dr Kishore. “When the virus is reactivated in these nerve clusters, it only affects the skin along these nerves."

Complications and secondary conditions can arise depending on where exactly the varicella virus was stored. “If it affects the cranial nerves, for instance, it can lead to blindness," says Dr Prabhusankar. “It can also cause an inflammation of the spinal cord and the brain (myelitis and meningoencephalitis) and facial paralysis."

It’s the final phase, however, that poses the most problems. PHN, or Postherpetic Neuralgia, usually begins three months after the boils crust over. Many describe it as an intolerable pain that can last for months, even years. “Not all those affected by shingles experience the PHN stage (especially if shingles is treated early)," says Dr Prabhusankar. “Antiviral drugs can help make the pain more bearable."

Prevention and precautions

Shingles is extremely contagious and most patients are advised quarantine and rest. If you have had contact with an infected individual, see your doctor as soon as possible. Get your children vaccinated for chickenpox, because if they’ve never had it, the vaccine could prevent them from developing shingles as well. If you have elderly parents (above 60), check with your doctor if they should get the shingles vaccine.

The vaccine is expensive (Rs7,500 approximately) at present but if you can afford it, it may be well worth considering—even though it is not foolproof. For, even if you’ve already had an episode of shingles, the vaccine could prevent you from contracting it again. Or if you do get it again, it could reduce the intensity of pain and suffering, offering at least some degree of protection.

At the very least, stay aware. Treating the disease in its early stages with oral drugs can provide a great deal of relief.

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