Greensburg resident Elaine Davis hopes a new vaccine will prevent outbreaks of shingles -- if not for her, then for the thousands of older adults at risk for the painful disease. The U.S. Food and Drug Administration approved a shingles vaccine, called Zostavax, on May 25. According to pharmaceutical giant Merck & Co., which produces it, Zostavax is the first vaccine that may prevent shingles in people age 60 and older. Davis, who has had four shingles outbreaks, said she immediately asked her physician if she could have the vaccine. But it is so new that guidelines are still being developed, and few doctors are offering it yet. "It is new," confirmed Richard McGarvey, spokesman for the Pennsylvania Department of Health. "We haven't started using it." Characterized by a blistering rash, shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. It typically affects people older than 50, but anyone who has had chickenpox -- an estimated nine out of 10 American adults -- is at risk for shingles. The National Institutes of Health estimates that 500,000 Americans will develop the disease this year. Davis, who is in her 60s, experienced her first shingles outbreak 30 years ago. "I had small children," she said. "The doctor thought I got it from them." Once a person develops chickenpox, the varicella-zoster virus -- also called herpes zoster -- never leaves the body. It remains dormant, sometimes for decades, until something reactivates it. "Shingles is an outbreak of the chickenpox virus," said Dr. Jeffrey R. James, chairman of the Infection Control Committee at Monongahela Valley Hospital. He also is on staff at hospitals in Uniontown and Washington, Pa. "Once you're infected and the virus is done with the acute infection, the virus lies dormant, particularly along nerve roots," James said. "It usually occurs on one side of the body in certain nerve-root distributions," producing inflammation and a painful, persistent rash. Shingles can develop at any time, but it seems most often to hit people whose immune systems are depressed. Age alone may increase the risk. Stress, either physical or psychological, can trigger an outbreak. So can chronic illness, use of steroids or certain cancer treatments. "Usually when shingles starts, in the area of the body where it will break out, people will feel a burning sensation or pain sensation," James said. "Within several days, small blisters will start up. It sort of looks identical to chickenpox." In most cases, the blisters crust over and begin to heal within five to seven days. In June, Davis experienced some pain in her neck after spending time gardening. "I thought I had poison ivy," she said. "It started as a little bit of pain in my neck. When the blisters came, I knew it was different." This was Davis' fourth bout with shingles, which is rare. Most people do not have repeated outbreaks. This time, Davis' rash spread from her neck to her arm. "I didn't want to go out," she said. "You don't feel right. You don't feel ill, but it's uncomfortable." Davis worried about people seeing -- not catching -- her rash. Although the chickenpox virus is highly contagious, shingles cannot be spread to others. However, a person with shingles can infect a person, usually a child, who has never had chickenpox, giving that person a case of the childhood disease. Because varicella-zoster can collect in clusters of nerve cells called sensory ganglia, an outbreak releases the virus along the nerve fibers. As the virus multiplies, the rash appears. The nervous system is more actively involved in a bout of shingles than of chickenpox, making the "returning" disease more complex and painful than the initial childhood illness. "It hurts like the dickens," said Davis, whose latest outbreak cleared up within two weeks. "One time I thought I would scratch myself inside out." Because the virus follows the path of nerve fibers, a shingles outbreak usually occurs on one side of the body only. The pattern of fluid-filled blisters can help doctors make a diagnosis. "The rash will come from the back to the front, but it won't cross the midline of the body," James said. Even after the rash has subsided, shingles can have lasting effects. Postherpetic neuralgia, or PHN, is pain that persists long after the blisters have healed. It can be mild or severe, leading to insomnia, weight loss, even disability. "You can have a lot of residual pain," James said. "After shingles are gone, you can be left with a terrible pain. If you can prevent shingles from happening at all, that is the key." Doctors can prescribe medication to ease the symptoms of shingles. Antiviral drugs, such as acyclovir, valcyclovir or famcyclovir, can reduce the severity of the outbreak if taken immediately after the rash appears. PHN can be treated with painkillers, steroids, antidepressants or antiseizure medications. Preventing shingles altogether is the goal of Zostavax, a stronger version of the chickenpox vaccine now routinely given to children. The shingles vaccine was studied in 38,000 American seniors who were monitored for three years. Half received the vaccine, a live but weakened form of the virus; the rest were given a placebo. In adults older than 60, the vaccine reduced the occurrence of shingles by 50 percent. For individuals ages 60 to 69, occurrence was reduced by 64 percent. Even in those people who developed shingles, the vaccine reduced the duration of pain, which can linger from three to five weeks. "It should be advantageous for decreasing the severity of the event," James said. "It's been approved for people who have not had a bout of shingles." The Pennsylvania Department of Health is waiting for recommendations from its Advisory Committee on Immunization Practices before it decides who should receive the vaccine. The committee is expected to address the topic this month. "We'll wait to see what they recommend," McGarvey said. Until then, people older than 60 should discuss the new vaccine with their physicians. Additional Information:

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What's in a name? The name 'shingles' comes from the Latin cingulum , which means 'girdle' or 'belt' -- a reference to the well-defined band of blisters that characterizes the disease. The U.S. Food and Drug Administration reports that in Italy the uncomfortable condition also is known as 'St. Anthony's fire.'

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