Banishing the Red Scourge of Old Age

Though the itchy red spots usually come and go within a week or two, becoming just another childhood memory, the chickenpox virus itself never leaves the body. Lying low in nerve cells, it often surfaces again decades later, causing an outbreak of painful blisters and rashes called shingles.

Especially among older adults, shingles is a quiet plague: It strikes about one in 100 Americans over the age of 65 each year, researchers estimate, and can erupt almost anywhere on the body. By the time the rashes clear, doctors say, the underlying skin can be discolored, or slightly numb.

“The nerve damage can be permanent,” said Dr. Ann Arvin, a pediatrician and infectious disease researcher at Stanford University School of Medicine, “even when people get treatment with anti-viral drugs.”

Doctors now suspect they can do better than treatment--preventing shingles altogether, in many people, by using the childhood chickenpox vaccine now given to millions of youngsters. In a study published last week in the New England Journal of Medicine, Arvin and a team of researchers reported that the vaccine reduced the risk of shingles in a group of cancer patients, who are at high risk of developing the rash due to weakened immunity. The vaccine--like chickenpox itself--stokes the body’s immunity to the virus, keeping the skin outbreaks in check.

The study included 111 cancer patients who were due to receive a bone marrow transplant to fight their disease. About half the patients got the chickenpox vaccine before the transplant; the other half got no vaccine. A year later, fully a third of those who were not vaccinated had developed shingles, while only 13% of the vaccinated group had developed the rashes. Arvin expects the vaccine to work similarly in people with AIDS, leukemia and other conditions that weaken the immune system.

That includes normal aging. Over time, the number of immune cells that recognize the chickenpox virus decreases, Arvin said. “You don’t have to have any underlying disease for this to happen; it’s simply a part of aging,” she said. “This is why the risk of developing shingles increases with each decade, we believe.” About half of those who live to age 85 will have had at least one bout of shingles in their lives, doctors say.

Already the government is funding a nationwide study, including more than 38,000 people age 60 and older, to see whether routine vaccinations of older adults will significantly reduce the incidence of shingles.

“It makes very good sense,” said the study’s director, Dr. Michael Oxman, an infectious disease specialist at the San Diego Veterans Affairs Medical Center. “The bottom line is that the older you are, the worse the pain is. The pain may last for months or even years after the rashes have gone and it doesn’t respond to any treatment that older people can tolerate.”

The impact of shingles on people’s lives is not widely appreciated, doctors say. It’s neither as frightening nor harmful as other viral diseases such as AIDS and hepatitis C, and the government doesn’t even track outbreaks of the rashes. Nonetheless, its sufferers know the story--and the value of prevention. “This is the kind of thing that destroys the lives of people who are looking forward to traveling and doing other things for retirement,” said Oxman.