Shingles Complications in the Elderly

Kathleen Dooling, MD, MPH

Anne Louise Oaklander, MD, PhD

Everyone who has had chickenpox-which is about 99% of the U.S. population over the age of 50-has the varicella-zoster virus (VZV) in their body, putting them at risk for developing shingles. Many of them may not realize just how painful and potentially debilitating shingles and its complications can be, especially among the elderly.

The segment of the population that’s most at risk for developing shingles is people over the age of 60, where about half of all cases occur. This is primarily because aging takes a toll on an individual’s immune system, making it harder for them to fight off infection. Stressful life events, immune-compromising conditions such as being treated for cancer, and even the common cold can weaken immunity.

Complications from shingles in the elderly can lead to serious, long-term health problems. They range from bacterial skin infections that can cause scarring and narcotizing fasciitis to hearing and vision loss, encephalitis, transverse myelitis, peripheral motor neuropathy, and postherpetic neuralgia (PHN).

“Epidemiologic studies have proven very clearly that age is not only the major risk factor for contracting shingles, but also for being left with complications such as postherpetic neuralgia,” explains neurologist Anne Louise Oaklander, MD, PhD, and the director of the Nerve Unit at Massachusetts General Hospital. “It’s likely because these patients get more severe infections to begin with because they have less immune defense, and also their nerves are less able to cope with the onslaught and recover.”

PHN occurs when the shingles rash goes away, but the pain doesn’t, and it can last for months or even years. PHN pain is felt in the same area where the rash was, and for some people it’s the worst and longest lasting part of shingles. Sufferers can experience depression, anxiety, confusion, trouble sleeping, and weight loss. Many have trouble with simple daily activities like dressing, bathing, and socializing due to the debilitating pain.

Fortunately, a highly effective vaccine against shingles is available and recommended for people aged 50 and above. Shingrix has been proven to be more than 90% effective at preventing shingles and PHN.  

Kathleen Dooling, MD, MPH, medical officer in the Division of Viral Diseases at the CDC, tells Drug Topics that Shingrix is an effective solution to overcoming some of the age-related decline in immunity.

“A lot of vaccines don’t work as well as we age because our immune systems are just not as robust as they were when we were younger,” she says. “The really remarkable advance with Shingrix is that this vaccine works almost as well in people 70 and older as it does for people in their 50s. That’s quite a remarkable achievement in vaccine development.”

Oaklander emphasizes that older people have a double need to protect themselves against getting shingles in the first place and against being left with complications if they do get shingles. She encourages all people who are eligible for the Shingrix vaccine to take advantage of it.

“Even in those cases of breakthrough shingles in somebody who’s been vaccinated, the severity of the shingles is so much less that people are exceedingly unlikely to have any of the dreaded complications-spinal cord damage, blindness, and deafness,” Oaklander notes. “Yes, you still have a chance of getting it, but the complication rate is much milder and the complication rate of postherpetic neuralgia is much, much lower.”  

Seniors should know that Medicare Part D will cover the shingles shot, as well as all other commercially available vaccines.