Understanding the Increased Risk of Shingles in Seniors
Shingles, also known as herpes zoster, is caused by the reactivation of the varicella-zoster virus (VZV), the virus responsible for chickenpox. After an individual recovers from chickenpox, the VZV remains dormant in nerve tissue. The virus can reactivate as the immune system weakens with age, leading to shingles. This is why the risk of shingles increases significantly in older adults.
While approximately one in three people in the U.S. will get shingles at some point, the risk is higher for seniors. The incidence rate becomes particularly notable for those aged 70 and above.
Shingles Incidence Rates for People Over 70
Studies indicate a significant lifetime prevalence of shingles in adults over 70. According to a 2016 study, the lifetime prevalence was 14.9% for those aged 70–74 and 17.1% for the 75–79 age group. Overall, about half of people who live to 85 will have experienced shingles. Annual incidence rates also rise with age, with an estimated rate of 1531 cases per 100,000 population in people aged 70–79.
Why Age is the Primary Risk Factor
The strong link between aging and shingles risk is primarily due to immunosenescence, the natural decline in immune system function that occurs with age. This weakens the T-cells necessary to keep VZV in check. Other factors contributing to increased risk in seniors include existing medical conditions like diabetes or cancer, and certain medications that suppress the immune system. Stress can also temporarily weaken the immune system.
Potential Complications of Shingles in Seniors
Shingles in older adults can lead to severe complications. The most common is postherpetic neuralgia (PHN), which causes persistent, long-term nerve pain. The risk and severity of PHN increase with age. Shingles affecting the eye (herpes zoster ophthalmicus) can cause vision loss if untreated. Rarely, shingles can lead to neurological problems like encephalitis or facial paralysis. Bacterial skin infections are also a risk if blisters are not properly cared for.
Comparison: Shingrix vs. Older Vaccine (Zostavax)
| Feature | Shingrix (Newer Recombinant Vaccine) | Zostavax (Older Live Vaccine) |
|---|---|---|
| Effectiveness (Age 70+) | 91% effective in preventing shingles | Much lower effectiveness in those over 70, with protection significantly waning over time |
| Protection Against PHN | 89% effective in preventing PHN in those 70+ | Less effective at preventing PHN compared to Shingrix |
| Vaccine Type | Inactivated (non-live) vaccine | Live, weakened virus |
| Recommended for Immunocompromised? | Recommended for adults 19+ who are immunocompromised | Not recommended for those who are immunocompromised |
| Dosing Schedule | Two doses, 2 to 6 months apart | Single dose |
| Availability in US | Widely available | Discontinued in the U.S. as of November 2020 |
Prevention and Treatment for Older Adults
The best way for older adults to prevent shingles is vaccination with Shingrix, recommended for healthy adults aged 50 and older. It is given as a two-dose series. Even those who have had shingles or the older Zostavax vaccine should get Shingrix.
If shingles develops, prompt treatment with antiviral medications within 72 hours of rash onset is crucial. These medications can shorten the illness and reduce the risk of PHN. Supportive care like cool compresses and pain relievers can help manage symptoms.
Managing an Outbreak at Home
Caring for someone with shingles involves managing symptoms and preventing the virus's spread. The virus can spread through contact with blister fluid to those who haven't had chickenpox. Avoid contact with high-risk individuals until blisters have scabbed over.
Home care includes keeping the rash covered, frequent handwashing, using cool compresses or oatmeal baths for comfort, and reducing stress. {Link: NCOA website https://www.ncoa.org/article/is-shingles-contagious-what-older-adults-need-to-know} for more information about symptoms to watch for.
Sources for Further Reading:
For additional information from a reliable source on shingles and prevention, visit the National Institute on Aging website.
Conclusion
Understanding the percentage of people over 70 who get shingles highlights the significant and increasing risk with age. The age-related decline in immune function makes seniors vulnerable to VZV reactivation. This, coupled with the potential for severe complications like PHN, emphasizes the importance of proactive health measures. Effective vaccines like Shingrix offer strong protection. Awareness of risks, preventative steps, and seeking timely treatment are vital for seniors and their caregivers.
