Nov. 27, 1999 (Atlanta) -- A new study may make the debilitating nerve and skin infection called shingles go the way of smallpox. Anywhere from 200,000 to 1,000,000 people are diagnosed with the condition in the U.S. each year. Countless more may go undiagnosed. Though not necessarily life-threatening, the virus can destroy a person's quality of life for weeks, months, even longer. And to date, there is no cure.
However, a vaccine study being conducted by the Department of Veterans Affairs, in collaboration with the National Institute of Allergy and Infectious Diseases and the drug company Merck, is the best bet yet for shingles prevention.
The same virus that causes chickenpox, called varicella-zoster virus (VZV), brings on shingles. When a person gets over chickenpox, the virus doesn't leave the body, but instead hides out in nerve cells on either side of the spinal cord. For many people, that's the end of it. "Once you have the chickenpox, the shingles are in you. They live in the dorsal root ganglia, and you have it for life, and 80% of the time nothing will happen -- you'll die with the thing in you," Richard Perkin tells WebMD. Perkin is the chairman of the VZV Research Foundation, a nonprofit organization fostering research and education on the virus.
For the other 20%, though, the virus returns, at any time, with a renewed vengeance and a new name, herpes zoster, or shingles. No one knows exactly what brings it about, but lowered immunity, brought on either by advanced age, stress, or disease, plays a role. Michael Oxman, MD, the national chairman of the VA study, which is using a vaccine similar to the one used to fight chickenpox, tells WebMD that "sooner or later, [VZV] wakes from its sleep, causing a great deal of damage, killing nerve cells." The virus travels along the nerve, usually causing pain along the way and resulting in an excruciatingly painful rash that usually lasts three to five weeks.
There's still more, for the unlucky few. It's called post-herpetic neuralgia, and it's likely brought on by the damage shingles does to the nerves. For the person who has it, it can mean prolonged pain for at least a month after the initial attack, and perhaps lasting for years. Changes in temperature, the touch of clothing, even a breeze can be enough to trigger terrible pain.
"It's neuralgic pain," says Oxman, who is also professor of medicine and pathology at the University of California, San Diego. "So it's not like a broken leg or a burn, which you can relieve with painkillers. This is pain that's actually generated in the nervous system, and it doesn't respond very well to any methods of controlling pain. It's a major cause of suicide."'
There are many options to relieve or inhibit pain in shingles sufferers, but none of them are routinely effective. They include antiviral drugs, which are often effective at lessening the duration of shingles if taken soon after an outbreak. "Antiviral drugs only stop further virus multiplication. They don't make a dead nerve cell come to life. So the earlier you get diagnosed and treated, the more likely it is to have some impact," Oxman tells WebMD.
Although no agreement has been reached on the appropriate management of shingles, steroids have been tried, as have antidepressants, anticonvulsants, and topical agents such as the anesthetic lidocaine, which has recently become available in patch form. For some, the lidocaine is effective at helping with the chronic pain, but as Oxman points out, it's hard to put it over your eye. About 15% of shingles sufferers are affected in that area, sometimes to the point of blindness. Perkin, whose mother had shingles, said she described the feeling as "having an icepick through your eye."
Other methods such as electrical stimulation and acupuncture are used, and in severe cases surgery is an option. But once the shingles awaken and come down to the skin, "the horse is out of the barn," Oxman says. Prevention is the key. Unfortunately, none of these approaches has been proven to prevent shingles.
The VA study "is an attempt to see if we can prevent shingles with a vaccine, and it's based on very compelling circumstantial evidence," Oxman tells WebMD. He and his colleagues are trying to enroll 37,000 people at 21 VA sites nationwide. So far, they've enrolled just over 6,000 people but are actively seeking more to reach their goal.
To qualify, the people need to be over 60 and to have had chickenpox, but not shingles. The reason for this, dating back to a landmark study in 1965, Oxman says, is that the incidence and severity of shingles apparently increases with advancing age. Most of the cases of shingles are seen in patients 60 and older. People who live to age 85 have a 50/50 chance of developing shingles.
The fact that the virus normally lies dormant until the later years suggests that a decreased immunity may play a role in triggering it. In addition, after a person with a healthy immune system gets shingles, they are unlikely to get it again, thus pointing to an immune response.
That's why this study is inoculating subjects with a vaccine similar to the one that's been effective in preventing chickenpox in children. Oxman says, "It doesn't take a lot of virus to do the job in children. What we have done is taken the same attenuated [weakened] virus of the children's vaccine, and just used more of it, nothing very complicated."
The project got underway in March. After inoculation, with either the vaccine or a placebo, the people will be followed for about four years.
"It's fundamentally a very simple-minded study," Oxman tells WebMD. "But there's a lot of work for safety reasons, because if this vaccine works, there's going to be 60 or 70 million older people who are going to want to get it in a relatively short period of time, and the FDA quite properly wants to have a lot more than the usual safety data [for approval]."
Whether this trial works, Perkins of the VZV Foundation tells WebMD, "the problem is going to ultimately be solved by vaccination -- we're pretty sure of that."
- Shingles is an infection of the nerve and skin that can cause excruciating pain for several weeks, months, or years.
- The virus that causes chicken pox is responsible for shingles. It remains dormant in the body after a bout with chicken pox and is triggered by lowered immunity, usually a result of aging.
- A large trial is currently underway to test a vaccine for shingles that is similar to the chicken pox vaccine used in children.