Late consequence of chickenpox: All about shingles

Only a temporarily weakened immune system separates you from an outbreak of shingles. In Switzerland, almost the entire population (98 per cent) carries the varicella zoster virus. In some people, the pathogen remains dormant forever after a chickenpox infection. For many, however, it is only temporary and the virus becomes active again.

Around a third of all people contract shingles after a chickenpox infection. The older you get, the greater the risk. Was die Gürtelrose akut auslöst, wie du dich bei Krankheits-Symptomen am besten verhältst und was es zu der kürzlich zugelassen Impfung zu wissen gibt, weiß Dr. Julian Maier from the Centre for Travel Medicine at the University of Zurich.

Why does a sudden outbreak occur?

Shingles (herpes zoster) is a late consequence of a chickenpox infection. And everyone is familiar with chickenpox - the highly contagious disease is usually unproblematic in childhood with fever and itchy pustules. If the disease strikes later in life, chickenpox is not harmless: in Switzerland, an estimated 3000 people over the age of 16 contract it every year - 60 to 70 of them are hospitalised due to complications. Pregnant women in particular should be careful: a chickenpox infection during pregnancy increases the risk of malformations in the unborn child.

Once you have been infected with the chickenpox virus (varicella zoster virus), the pathogen remains permanently in your nervous system, settles in your spinal cord and lies dormant there. Why are the varicella cells reactivated and why does shingles then break out? This is usually due to a temporary immune deficiency, says Dr Maier.

"Stress or infectious diseases such as a cold or stomach flu are often enough. Medication that has an immunosuppressive effect can also favour an outbreak. Shingles can also be the first sign of cancer."

However, the most important factor in favour of shingles is age: "The immune system becomes weaker with age and its ability to fight off other diseases decreases. This starts around the age of 65," says the expert. In Switzerland, for example, 50 per cent of cases of shingles affect people aged 65 and over

How does shingles make itself felt?

The most important symptom of shingles is the distinctive skin rash. The varicella zoster viruses, which have nested in the spinal cord after chickenpox, travel along the nerve cords to the skin, where they form an inflammatory, painful rash with small blisters. This rash develops at the end of the nerve tracts where the varicella cells have travelled to the surface of the skin. There it resembles a belt (at least in the trunk area) - hence the name "shingles". In principle, the rash can also occur on the chest, arms or face.

"Shingles is particularly dangerous in the facial area," warns Dr Maier. This is because not only the skin, but also the visual and auditory nerves can be affected. "If you don't start treatment straight away, you can go blind or lose your hearing." In 10 to 20 per cent of shingles cases, an eye is also affected.

Another harbinger of shingles often appears days before the rash: "Pain can occur one to five days beforehand where the rash later appears," says the expert. This may be mild and only noticeable to the touch, but tingling or more severe pain is also possible. Fever can also occur, says the expert.

Therapy and treatment

If you feel the first symptoms, it is best to consult your GP straight away. This is because the success of treatment for shingles depends on how quickly treatment is started. Dr Maier advises: "It is important to inform your doctor if you suspect shingles." You should also cover your rash at the doctor's surgery: This is because the vesicle fluid contains the chickenpox virus, which makes the rash highly contagious.

There are two treatment options: symptomatic and antiviral treatment. "Antiviral treatment should be started as soon as possible, as this can shorten the duration of the illness," says the expert. This is done in tablet form and inhibits the reproduction cycle of the varicella cells: "This makes the virus less able to spread. The body also forms antibodies and reduces the risk of further shingles."

At the same time, the painful rash must be treated: "Symptomatic treatment consists of pain medication and a white shaking mixture that is applied to the rash. The remedy relieves the itching and dries out the blisters". Two to four weeks later, shingles is often healed.

Consequential disease of shingles

However, according to a study by the University of Zurich, 10 to 15 per cent of shingles patients suffer from post-zoster neuralgia after the disease. It is a secondary disease that is associated with severe nerve pain that often lasts for months, if not years. Post-zoster neuralgia is when the pain can still be felt 90 to 120 days after the onset of the disease.

"The varicella cells migrate to the skin via the nerve tracts. If the inflammation on the skin does not heal properly, the pain can persist," says Dr Maier. Regarding the risk factors, he says: "The older you are, the more common post-zoster neuralgia is. And the more severe the pain during shingles, the more likely a secondary disease is."

Preventing shingles: who is the vaccination recommended for

Shingles is an underestimated risk that almost everyone carries. If you act quickly, it can be easily controlled. If you wait too long, you run the risk of serious secondary diseases.

The good news: since 2022, you can even take preventative measures to protect yourself against shingles. The "Shingrix" vaccine has been authorised in Switzerland since last year and is recommended for all people aged 65 and over or with certain immune deficiencies: "We recommend the vaccination to anyone who is severely immunocompromised. For example, if an organ transplant is planned, you should be vaccinated beforehand because you will be on immunosuppressive therapy for the rest of your life afterwards," says the expert.

Two doses of the vaccine are injected two months apart, which then protect you 90 to 97 per cent against shingles. After an outbreak of shingles, you should wait two months after the rash has healed before getting the vaccine.

A vaccination against chickenpox has been recommended for children aged nine to twelve months since the beginning of 2023, writes the Federal Office of Public Health. Experts recommend the vaccination in combination with measles, mumps and rubella. This can reduce the risk of chickenpox and therefore shingles at an early stage.