Feature Article: Chickenpox, Shingles and … Justin Bieber?

Before Justin Bieber announced that he had Ramsay Hunt syndrome, most people probably had not heard of it, and many may still not realize that this syndrome, characterized by facial weakness or paralysis, is a form of shingles. Indeed, shingles can appear in several forms, so let’s take a look.

How does someone get shingles?

Shingles is caused by varicella zoster virus, the same virus that causes chickenpox. This virus is known for its ability to remain in nerve cells after a chickenpox infection. This means that anyone who has had chickenpox can develop shingles. Because the chickenpox vaccine is a weakened live virus, it is possible that an individual who was vaccinated could also get shingles. However, the likelihood of an occurrence of shingles following vaccination is much lower and the symptoms much less severe than shingles following natural infection. Importantly, a person with shingles cannot give another person shingles, but if they have a rash, the virus particles associated with the sores could cause someone to get chickenpox if they come into contact with the sores and have never had chickenpox or the chickenpox vaccine.

Shingles occurs when the virus that remained in nerve cells reactivates. Reactivations are more likely as people get older because our immune systems weaken as we age. Likewise, people may get shingles during periods when they have weakened immunity, such as during times of illness, treatment, or even extreme stress.

What are the symptoms of shingles?

The most common symptoms of shingles are pain and a rash. The pain, called post-herpetic neuralgia (PHN), is often severe and debilitating, lasting even after the rash has disappeared. The pain can be so severe that individuals cannot wear articles of clothing that touch the area or complete common daily activities. For most people that pain resolves within weeks to a few months, but for some, it can be felt more than a year after the episode.

The location of the pain and rash depends on where the virus is replicating, and because the virus is in nerve cells, symptoms typically develop along a line that follows a nerve. In Bieber’s case a facial nerve by one of his ears appears to have been involved, but as you can see from these personal stories shared on our Parents PACK website, different nerves are involved for different people, and in individuals who experience shingles more than once, they may not necessarily have it in the same location. For example:

• Nancy, whose experience with shingles was recently posted on our site, first noticed a rash and pain on her back before the pain spread to her front and intensified over the next few days.
• Paula described her pain as feeling like “a lightning bolt hit her head.” She experienced multiple episodes of shingles.
• Amanda’s experience began with an itchy leg. She too endured numerous episodes, describing how years later she still had lingering pain.
• Kevin first noticed pain and a blister on his head when he took his motorcycle helmet off, but soon a rash and redness developed near his eye and on his forehead.
• Jim’s experience started when it felt like he had something in his eye. As his symptoms developed, they were centered around his eye, requiring specialized medical care regularly for a year, limiting his ability to work and eventually requiring eye surgery.
• A graduate student, who got shingles when she was 28, also had eye involvement.

Check out each of these stories to learn more. We are always grateful when someone is willing to share their experience, so others can learn from them.

How can shingles be prevented?

Since virtually everyone got chickenpox before a vaccine became available in 1995, most adults can get shingles. As such, all adults 50 years of age and older are recommended to get the shingles vaccine, called Shingrix^®. The vaccine contains a single protein from the surface of the varicella zoster virus and two adjuvants that help our immune systems develop a more robust response to the vaccination. It is given as two doses separated by two to six months.

A previous version of shingles vaccine, known as Zostavax^®, was just a larger dose of the chickenpox vaccine and, therefore, contained live, weakened virus. It did not work as well as Shingrix, so it is no longer available. Individuals who previously received Zostavax are recommended to get Shingrix for better protection.

Final thoughts

If you reviewed the stories that people have shared on our website, followed Bieber’s story, or know someone who has had shingles, you likely realize that shingles can be life altering. The vaccine works and is safe, so don’t end up feeling like Nancy:

“One difficult aspect of getting shingles was that I had to tell my sister-the-doctor who specializes in vaccinations that I had not gotten the shingles vaccination. You can imagine how that went over and how foolish I felt realizing that I could have avoided this whole episode. ... My only reason for not getting it? I just didn’t get around to it …”

Additional information about shingles

• A Look at Each Vaccine: Shingles (webpage)
• Shingles: What you should know (PDF), English | Spanish
• Do I Need to Avoid Being Around Infants After Getting a Shingles Vaccine? (video)
• Rashes: What You Should Know (booklet), English | Spanish

Download a PDF version of this article.