Joe Daly calls himself one of those guys who doesn’t like going to the doctor.
So when he developed a red, itchy patch on his rib cage in June, he shrugged it off.
“I thought I just maybe had rubbed up against something in the woods on a canoeing trip,” he said.
Two weeks later, the rash had become the size of a baseball and was so sore he could no longer ignore it. The pain drove Daly, of Rockford, Michigan, to seek help at the Spectrum Health Urgent Care facility on the East Beltline in Grand Rapids.
The doctor who saw Daly took one look at the rash and diagnosed it immediately: shingles.
Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. Once a person has had chickenpox or been vaccinated against it, the virus lies dormant in the nerves along the spinal cord and can reactivate decades later, causing the painful shingles rash.
The booster effect
Most people think of shingles as a senior citizen’s disease.
Daly, however, is only 31 years old.
That’s young for a shingles diagnosis, but not unheard of. According to the Centers for Disease Control, the incidence of shingles is increasing among adults in the United States. This includes an increase among younger adults, although a person’s risk increases sharply after age 50.
Born in the mid-1980s, Daly is among the last generations of Americans who routinely contracted chickenpox as children. The chickenpox, or varicella, vaccine was introduced as a routine childhood vaccination in 1996.
Some experts are concerned that people in Daly’s generation will see an increase in shingles cases as adults because they’re not receiving the booster effect that comes from repeated exposure to chickenpox.
Brian Petroelje, MD, an infectious disease specialist with Spectrum Health Medical Group, thinks there may be some truth to this theory.
“When you are exposed to the chickenpox virus or the vaccine the first time, you form antibodies to protect you in the future,” he said.
Repeat exposure leads to a boost of antibodies that reduces your risk of shingles.
“Historically, you would get exposed as a kid, and then when your kids and grandkids got it, you got re-exposed and would get a natural boosting effect each time,” Dr. Petroelje said.
Today, thanks to childhood vaccinations, community outbreaks of chickenpox are rare—and so is the opportunity for exposure.
But Dr. Petroelje cautions that this explanation doesn’t fully account for the increased shingles trend. For example, he said, the trend also exists in parts of the world without routine vaccination, and the increase in the U.S. began before the chickenpox vaccine came on the scene.
“It’s not clear what other factors are contributing,” he said.
Dr. Petroelje remains a firm believer in the value of the chickenpox vaccine.
“As kids who were vaccinated become adults, we may actually see a decline in shingles in the future,” he said.
Adults who want to protect themselves against shingles can request the shingles vaccine, Zostavax. According to the CDC, Zostavax is recommended for those who are at least 60, although the Food and Drug Administration has approved it for people as young as 50.
For those younger than 50, the shingles vaccine isn’t covered by insurance because its effects have not been studied. However, if younger adults wanted to pay for it out of pocket and their health care provider is willing to administer it, Dr. Petroelje said he wouldn’t expect any adverse effects as long as they (and anyone around them) don’t have suppressed immune systems.
If, in the future, it becomes clear that the chickenpox “vaccination effect” is leading to more shingles, he said, then someday we could see a recommendation of a booster vaccine dose in early adulthood.
For a younger person like Daly, there’s no predicting whether he’ll have to deal with shingles again. People typically get it only once, but second and third episodes are possible.
If he ever gets it again, Daly hopes to recognize it sooner. The antiviral shingles drugs work best when started as soon as the rash appears.
Daly said things could have been a lot worse. His case of shingles didn’t lead to complications, nor did it keep him from his weekly round of golf.
In fact, he said, “I actually golfed the best round that I ever have the other week at golf league.”