New Delhi: Shingles, often dismissed as a painful skin condition, has far-reaching health implications beyond its characteristic rash. Recent studies reveal a concerning link between shingles and an increased risk of cardiovascular events, with this risk persisting for over a decade.
In an exclusive interaction with Rashmi Mabiyan Kaur, Dr. Randeep Guleria, Chairman, Institute of Internal Medicine & Respiratory and Sleep Medicine, Medanta, Delhi, sheds light on the broader impact of shingles, its connection to chronic diseases, and why even younger adults with weakened immunity are at risk. He also addresses the urgent need for greater awareness about shingles vaccination in India and the role of prevention in protecting high-risk populations.
Q. Many people assume shingles only affect older adults. Who is at risk, and how does age or underlying health conditions increase susceptibility?
While shingles is more common in older adults, it is not limited to them. Anyone who has had chickenpox carries the varicella-zoster virus (VZV) in their nerve cells, where it remains dormant. When the immune system weakens, the virus can reactivate and cause shingles.
Age is a primary risk factor due to immunosenescence, the gradual decline in immune function that occurs as we get older. More than 90% of adults over 50 have the virus in their system and are vulnerable to reactivation.
Individuals with compromised immune systems are at risk. Conditions such as diabetes, cardiovascular disease, chronic lung disease, kidney disease, and cancer impair immune function, making it easier for the virus to reactivate. Patients undergoing chemotherapy, radiation, or long-term steroid therapy are particularly vulnerable, as these treatments suppress the immune system.
Recently, studies have also suggested that individuals who have had COVID-19, particularly those hospitalised, face an elevated risk of shingles due to immune system dysregulation.
Q. Research suggests that people with chronic diseases like diabetes, cardiovascular disease, and cancer may have a higher risk of developing shingles. Could you elaborate on this connection?
Yes, chronic illnesses significantly increase the risk of shingles. This is largely because these conditions suppress immune function, creating an environment where the varicella-zoster virus can reactivate.
Patients with diabetes face a significantly higher risk of shingles, with studies indicating an increased likelihood compared to non-diabetic individuals. High blood sugar levels weaken the immune system and promote chronic inflammation, further reducing the body’s ability to suppress the virus.
For cancer patients, particularly those undergoing chemotherapy or radiation therapy, the immune system is already severely compromised, putting them at an increased risk of shingles.
When shingles occur in immunocompromised individuals, it can lead to disseminated lesions, prolonged illness, and a greater risk of severe complications such as organ involvement and neurological issues.
This strong association between chronic illness and shingles highlights the urgent need for awareness. A recent survey shows that 61 per cent of participants reported living with a chronic condition, but only 49.8 per cent of those with chronic conditions were concerned about their shingles risk. Given that these individuals are more likely to experience severe and prolonged shingles episodes, it is essential that those in high-risk groups consider proactiveness toward the prevention of this illness.
Q. Does shingles increase the risk of complications or worsen pre-existing conditions in older adults?
Absolutely. Shingles is not just a temporary skin condition; it has the potential to cause long-term complications, particularly in older adults and individuals with pre-existing health conditions.
One of the most significant complications is postherpetic neuralgia (PHN), a condition where nerve pain persists for months or even years after the rash has healed. This occurs because the virus damages nerve fibers, leading to constant pain signals being sent to the brain, even in the absence of a rash. PHN is particularly common in older adults. In some cases, the pain is severe enough to interfere with daily activities, sleep, and overall quality of life.
Beyond nerve pain, shingles can also worsen existing chronic conditions. For example, in diabetic patients, blood sugar levels might increase despite adherence to recommended therapy and diet. They require a change in their medications, and their frequency of doctor visits tends to increase.
Shingles is also associated with a higher risk of stroke and heart attacks. Studies have shown that individuals with a history of shingles have an increased risk of cardiovascular events, with this risk persisting for over a decade. The inflammation caused by shingles can damage blood vessels, contributing to long-term vascular complications.
Beyond these complications, blisters near or in the eye may cause lasting eye damage and blindness. Hearing loss, brief facial paralysis, and inflammation of the brain, called encephalitis, can also occur.
Q. Given the link between shingles and weakened immunity, how do stress, lifestyle, and poor health contribute to the reactivation of the virus?
The virus that causes shingles remains in our bodies in a dormant state after a chickenpox infection. A well-functioning immune system keeps it suppressed. But when our body is under constant stress, it leads to high cortisol levels that negatively impact our immune function. When our immunity is weakened, it can lead to the reactivation of the dormant virus, causing shingles.
Similarly, people who suffer from poor health because of chronic conditions such as diabetes are also at risk of shingles. This is because diabetes can impair white blood cell function, making it easier for the virus to reactivate.
There is some research that shows the link between obesity and the reactivation of the virus to cause shingles.
If you are above the age of 50, it is important to follow a healthy lifestyle, manage stress, and talk to your doctor about shingles and its prevention.
Q. Shingles is a vaccine-preventable disease, yet awareness about the shingles vaccine remains low in India. What are the key reasons for this gap, and how can we address it?
Many people believe that shingles is just a skin condition and need not be considered serious. In some parts of the country, the disease is shrouded in myths and misconceptions and is often seen as a bad omen. In Maharashtra, for example, shingles has an interesting name: Naagin, because the shingles rash looks like the bands of a snake and appears on just one side of the body.
We need to dispel these myths and educate people above the age of 50 about the seriousness of this condition. We need to make them aware of how it can lead to severe complications that affect their quality of life.
It is important to understand that we don’t know how to halt the reactivation of the virus by any other means apart from prevention. Vaccination is one of the options to protect aging adults from the debilitating consequences of shingles.
Who should get vaccinated and at what age? Are there any special recommendations for immunocompromised individuals?
I would recommend that all people over the age of 50, regardless of their immune system status, speak to their doctor about shingles and its prevention. Shingles and its complications can be prevented through vaccination. This is because shingles and its complications can deteriorate the quality of life in the short and long term, especially for adults above 50 years of age, and can increase their dependence on caregivers.
