Shingles

Shingles is caused by the Varicella-zoster virus (VZV), a herpes virus also known as HHV-3 (human herpesvirus 3). This is the virus that causes chickenpox. Shingles is a painful rash with blisters that can affect any part of the body, but it usually appears as a band on one side of the body. In some cases, the rash appears on one side of the face. A herpes zoster infection can be very serious. It can cause complications such as vision loss or debilitating nerve pain.1

Chickenpox 2, 3

Chickenpox is a highly contagious disease with attack rates varying between 61 and 100% of unprotected people. Before vaccination against chickenpox, in countries with a temperate climate, it was estimated that at least 90% of individuals under 15 years of age and at least 95% of young adults had already had chickenpox. This infection occurs at a later age in tropical countries. A universal public immunization program against chickenpox was established in Quebec in 2006. Since then, there has been a significant decrease in the incidence of chickenpox and an approximately 70% decrease in medical visits and hospitalizations associated with this diagnosis and its complications. In the United States, the decrease in the incidence of the disease varies between 70% and 90%. However, outbreaks continue to occur, mainly in daycares and schools. Chickenpox cases most often occur in late winter and early spring.

Chickenpox is characterized by a fever accompanied by a maculopapular rash (small spots that rise on the skin, insensitive and do not contain liquid) that quickly becomes vesicular,
generalized and itchy, which will begin to
become crusty in 24 to 48 hours Various mucous membranes (conjunctives, oropharynx, genital mucous membranes) can also be affected. Chickenpox usually heals within 1 to 2 weeks. The most common complications are cutaneous bacterial superinfections and scratch injuries. Chickenpox can be complicated, especially in adults, by lung damage. Neurologic, hematological, articular and ophthalmological complications are also possible but rare. Neonatal chickenpox can be severe if chickenpox occurs in the mother under
5 days before delivery.

The contagious period begins 1 or 2 days before the onset of the rash and persists for up to 5 days after or until all the lesions are crusty. In mild cases, the lesions may become crusted more quickly. Immunosuppressed individuals with prolonged chickenpox may be contagious as long as new lesions continue to erupt.

Vaccination is the best way to protect against chickenpox and its complications.

The origins and symptoms of shingles 4, 5, 6, 7

During chickenpox, the virus has spread through the bloodstream and infected groups of nerve cells (nerve ganglia) located in the spinal cord or cranial nerves. The virus then remains in these nerve ganglia in a dormant (latent) state. The virus may never occur or reactivate after several years. During reactivations, the virus travels in the opposite direction along the path of nerve fibers to the skin, which then presents painful pimples similar to those of chickenpox. Shingles is much less common in children than in adults.

The first symptoms are a burning and tingling sensation in the affected area. One to three days later, redness and small, fluid-filled pimples (vesicles) appear in clusters and cause itching. The blisters eventually dry up and disappear after two to three weeks.

A person with shingles does not transmit it, but they can transmit the chickenpox virus. Direct contact with herpes zoster lesions is necessary for the transmission of the chickenpox virus. The lesions are contagious until they are scab, about a week after symptoms appear. The majority of cases of herpes zoster are quite common and heal spontaneously, but unlike chickenpox, the body cannot immunize itself against recurrences in the form of herpes zoster and the most common complication is therefore simply “recurrence”.

People who take medications (cortisone, cancer treatment, medications that could weaken the immune system) or who suffer from a condition that decreases their defenses against infections (leukemia, HIV) are at greater risk of complications. Likewise, a pregnant woman who has never had chickenpox and who has never
A person who has been vaccinated should also consult a doctor after contact with a person suffering from this disease.

Unfortunately, after the lesions have healed, the pain may persist. This is called post-zoster neuralgia. This pain is constant and characterized by a burning sensation or electric shock in the affected region that can last for months and even persist for life. The majority of people (60 to 90%) suffer from very severe pain, sometimes so severe that it is mistaken for a heart attack, sciatica, or appendicitis. Disseminated herpes zoster is possible in immunosuppressed individuals.

This pain can have several consequences on the patient's quality of life such as fatigue, insomnia, episodes of depression and anxiety as well as a decrease in appetite that can lead to weight loss.

Prevention and treatments 8, 9

Vaccination is the best protection against herpes zoster and its complications. There are two vaccines against herpes zoster.

The first, called Zostavax, is composed of the weakened virus. Its effectiveness in preventing shingles is around 50%, but decreases with age and the number of years after vaccination. However, if the disease develops in a person who has already been vaccinated against herpes zoster, the risk of neuralgia, that is, pain that persists for several months after the lesions have disappeared, is greatly reduced. A single dose of this vaccine is recommended. Vaccination with Zostavax is not recommended for immunocompromised persons because the risk of infection by the virus is real.
Indeed, it is a live attenuated vaccine and like all vaccines of this type, it is risky for these people to receive it.

The second, called Shingrix, is made from pieces of the virus. It has been available since January 2018 in Quebec. This vaccine is effective at
97% to prevent shingles and 89% to prevent neuralgia. The protection offered by the vaccine would be maintained for at least 4 years after vaccination. Two doses, spaced 2 to 12 months apart, are required to ensure long-lasting protection.

The choice of the vaccine is up to the doctor who will make the decision based on the patient and his health condition.

Only fluid-filled pimples are contagious. In other words, when the lesions are crusted, there is no longer a risk of catching the disease. If you have never had chickenpox and you touch the blisters, you can contract the virus. Hand washing is therefore essential to prevent transmission. Pregnant women who have never had chickenpox should avoid contact with someone affected (shingles or chickenpox) as there are risks for the baby.

Treatment should be started as soon as possible

Ideally within three days of the onset of lesions for maximum effect. You should definitely consult a doctor when the first symptoms appear. The doctor will then prescribe an antiviral, that is to say a medication that will attack the virus. Also, if you experience pain, it is possible to take painkillers in addition to the antiviral.

There are several non-drug tips to ease symptoms and prevent complications:

• Apply cold packs to the lesions.

• Gently clean the lesions and keep them dry.

• Do not scratch or pierce blisters.

• Wear light clothing to reduce friction on the lesions.

• Get some rest.

As with many diseases, a healthy lifestyle can reduce the risk of getting shingles (good eating habits, adequate rest, physical exercise).

Sébastien Puli Administrative assistant
Tomy-Richard Leboeuf McGregor Writer

Bibliographical references

1. https://www.ontario.ca/fr/page/recevez-le-vaccin-contre-le-zona-gratuitement

2. http://publications.msss.gouv.qc.ca/msss/fichiers/guide-garderie/chap7-varicelle-zona.pdf

3. https://fr.wikipedia.org/wiki/Virus_varicelle-zona

4. https://www.brunet.ca/fr/conseils/la-zona.html

5. http://www.canalvie.com/sante-beaute/sante/index-des-maladies/zona1.1055724 7. http://publications.msss.gouv.qc.ca/msss/fichiers/guide-garderie/chap

6. https://www.brunet.ca/fr/conseils/la-zona.html

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