Understanding Herpes Zoster (Shingles): Causes, Symptoms, Complications and Vaccines

For some time now, the issue of herpes zoster (HZ) or shingles, as it is popularly known, is everywhere. Radio, television, and newspaper advertisements and a plethora of posters flood the streets with rashed bodies. A phenomenon that arouses attention and coincides temporarily with the approval by Anmat of the vaccine made by GSK to prevent severe forms of this disease in immunocompromised adults over 50 and over 18 years of age. In parallel, although due to the visibility that the disease has acquired, an increase in cases could be foreseen, the specialists consulted by this newspaper and the Ministry of Health assure that The country is not in a more complex scenario.

The origin of the viral infection caused by herpes zoster It is related to the reactivation of the varicella zoster virus.. That is: only those individuals who had chickenpox as children or adolescents face the possibility of having herpes. A disease that remains hidden and that can wake up, especially from advanced adulthood. This is how Mario Lozano, a Conicet virologist, explains it: “It is the virus that causes chicken pox when we are young and shingles when we are adults. If there is a regrowth in society, it is not due to an increase in contagion; since practically 100 percent of the population has the virus inside the body since we were little. What the virus really does is reactivate itself, fundamentally, when our defenses are down for some reason.”.

Bettina Seoane, pediatrician and vaccine medical manager (southern cone) at GSK coincides with Lozano’s diagnosis. “There is no outbreak, but there is a reality: despite the fact that it is a disease that has always been around, it is not so well known. There are very few people who understand the severity linked to the pain complication.” And he continues: “It is a problem that in some cases lasts for several years and prevents you from being able to put on your clothes and when you go to bed you have to prevent the sheet from touching your body.”

According to data collected by the Argentine Society of Infectious Diseases (SADI)it is estimated that more than 99 percent of adults over the age of 40 have been infected with the varicella zoster virus and may develop shingles. Between 20 and 35 percent of immunocompromised people will have an HZ episode in their lifetime; This percentage increases to 50 percent in the case of people over 80 years of age who have not previously suffered from it.

Rash, complications and India ink

“It is not something very serious, on the contrary, it is a disease that is characterized by very low rates of really serious problems. They are viruses that lodge in the central nervous system and use a series of nerve cells as a place where they settle”, says Lozano. And he continues: “It has low replication in the body, but it can be released into the dermis where it is usually fought by white blood cells. However, if the individual has low defenses, the virus can proliferate and cause the characteristic skin lesions.

The infection is expressed through a skin rash, which can last up to a month. Patients also experience itching, tingling sensations, and sensitivity to touch. As the days go by, the blisters turn into scabs that disappear within weeks. However, on some occasions, the picture can be complicated and cause pain that spreads through the nerves and skin (caused by postherpetic neuralgia) that potentially lasts from three months to many years.

Once the rash is detected and, as is usually recommended for other pathologies, it is vital to consult a trusted doctor. This is how Seoane refers to it: “It is important to arrive with the treatment on time, because not doing so can complicate things. In general it can be treated with antiviral medication and if it is not done it can cause various risks. It can occur in the thorax, or it can occur in the eye and lead to loss of vision.”.

Often people are deceived and resort to home cures that promise false effectiveness. India ink, once considered an antiseptic, is nothing more than a myth insofar as it produces no benefit in reversing infection.

Vaccines, campaigns and interests

Although HZ is the same virus that causes chickenpox, the vaccine that people get at 15 months and six years (per the mandatory schedule) does not cover shingles. In 2014, Argentina had a vaccine that specifically sought to prevent severe forms of this infection, but this technology is currently not available.

Towards the end of March of this year, Anmat approved a vaccine designed by the GSK laboratory, a formula that in 2017 had already obtained the approval of the FDA, the United States regulatory body. The platform, which is administered in two doses and whose protection spans a decade, was 97 percent effective in clinical trials. As was the case with the covid, although it does not prevent the disease, it is useful to prevent serious cases. To date, the vaccine is recommended in immunocompromised people (individuals with HIV, transplant patients, and oncohematology), over 18 years of age at risk, and over 50 years of age.

In dialogue with this newspaper, sources from the Ministry of Health indicated that “Although this vaccine was approved by Anmat, to date it has not been acquired nor is it provided by the Ministry of Health. The vaccine is available in the private subsector and its indication is individualized, by the family doctor”.

In the 21st century, laboratories are very powerful corporations dedicated to providing solutions for the field of health. Like any company, they have their interests: they invest money in clinical trials and then want to get it back. From here the fact of the advertising campaign is explained so that society knows about the disease and knows that there is a vaccine. “The awareness campaign is geared towards pain experienced by different people. It is not linked to an increase in cases, because in fact there is not. Really, as a medical director, the first thing I want is for people to know about the disease”, details Seoane. Later he admits: “It is true that a vaccine was launched and that we are trying to make it accessible to as many people as possible.”

In this framework, it is essential that the flood of advertising does not translate into an alarm message for society. Above all, when the alarm, in part, seems to be unjustified.

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