Shingles are the most unwanted aspect of any immuno-compromised patient. They can be a nightmare. Not convinced? Just look at your webmasters picture below. Click on it for a bigger view if you wish. Not a pretty sight is it?
This page is here because anyone who has a compromised immune system is at higher risk to get shingles. That means patients who have had an SCT have a very high risk of getting them, and even chemotherapy patients are at increased risk.
Shingles is caused by the herpes zoster virus. This is the same virus that causes Chicken Pox. The only people who can have shingles are people who have already had chicken pox.
After your chicken pox heals, some of the virus travels down a nerve until it reaches the base of the nerve near your spine. It will lay there dormant, just waiting for a chance to re-awaken. For many people that will never happen but for anyone who has a compromised immune system it can easily happen. When it does the virus travels back up that same nerve until it comes to the surface. Since all your nerves only go to one side of your body, shingles will break out only on one side or the other. It is easily identified because the blisters appear only on one side of the body. Just look at my picture above to see how obvious it is.
Shingles are usually extremely painful and can leave permanent damage in the form of Postherpatic Neuralgia. This PHN as it is called, can last for a few weeks or months, and in some cases years.
Patients who have had an SCT are at very high risk of getting shingles at some point. It could be months, or years after their SCT. Their compromised immune system means that the herpes zoster virus is just looking for an opportunity to awaken once again.
There is nothing you can do to stop a reoccurrence or cure shingles. But there is something you can to that may lessen the severity of the outbreak and reduce the chance of PHN. Antiviral medications, if taken within 48 hours of the first sign of shingles rash/blisters can reduce the severity, duration, and risk of later complications. Three of the most commonly prescribed antiviral medications are Acyclovir, Famciclovir, Valacyclovir. These medications need to be taken within 48 hours of the first outbreak in order to be effective and reduce the chance of PHN.
You would do well to carry a prescription for any one of those in your wallet/purse all the time. If you happen to be somewhere where you do not have access to a doctor in less than 48 hours then this prescription means you can start therapy quicker, which may make a big difference.
Anyone over the age of 50 should talk to their doctor about the shingles vaccine. The currently approved shingles vaccine is Zostavax, but it is not approved for use in people who are immune compromised including anyone with lymphoma. Primarily this is because their immune system may not mount an immune response to the vaccine, meaning the vaccine won't work. It does not mean that the vaccine is dangerous to them.
There is a newer vaccine under development. In a phase III study in patients under 50 it achieved over 97% efficacy at preventing shingles. In the trial of patients over 70 it still achieved over 90% efficacy. That compares with just 50% for Zostavax. Below are the Glaxo Smith Kline press release and the actual published study in the NEJM.