Before a vaccine came along in 1995, virtually all children in the United States used to get chickenpox. Ironically, the success of that vaccine has led to an increase in a side-effect of chickenpox in adults: shingles.
A vaccine for adults can prevent shingles. Earlier this month, the U.S. Centers for Disease Control and Prevention recommended it for all adults age 60 and older.
Shingles is a nerve infection caused by the chickenpox virus, Varicella zoster. After a case of chickenpox, the rash goes away but the virus doesn't. It hides out in spinal nerves.
When immunity dips later in life — because of stress, disease or just normal aging — the virus can become painfully active again. That causes shingles.
Viola Stover's bout of shingles started a few weeks ago.
"It started out with an itching," the 60-year-old retired security guard says from her home in League City, Texas, between Houston and Galveston. "I thought, well, maybe I'm allergic to something. And it just seemed like it got worse and worse."
Then, blisters erupted on her back. And the pain started.
"The pain is like having a jagged knife in your chest and just turning it," she says. "I mean, it's the worst pain I think a person could ever go through."
Patients tell doctors that the pain of shingles is worse than that of giving birth. Worse than a heart attack. For Stover, the agony brought back childhood memories.
"I watched my grandmother — bless her heart — suffer with it," she says. "And I watched my mother suffer. My mom would scream with pain."
In fact, Stover blames her mother's death from alcoholic liver disease on shingles pain that never went away.
"My mom detested alcohol," she says. "She never allowed it in the house. But my mom was the type ... she never would take medication. I know for a fact that my mom was hurting so bad that that's why she turned to alcohol."
Dermatologist Stephen Tyring was struck years ago by how often shingles plagues several generations in one family.
"We started asking people, 'Have you had blood relatives with shingles?'" Tyring says.
That turned into a study at the University of Texas in Houston — the first to look at some families' propensity to get shingles. Results from the ongoing study appear this month in Archives of Dermatology.
"Almost half the patients now have said, 'Yes, I've had a relative or relatives with shingles,'" Tyring says. "And we found that if it were a first-degree relative — a parent, sibling or child – their chances appeared to be about doubled. But if it was two first-degree relatives, it seemed to be about quadrupled."
He thinks that's because some people's immune systems are genetically predisposed to shingles. It probably has to do with mutations in genes that code for proteins regulating the immune system.
The incidence of shingles is rising — not just among the elderly, but also in younger adults. "The theory," Tyring says, "is that as more and more children get vaccinated against chickenpox, there's less wild-type chickenpox virus around."
Consequently, children don't bring the virus home, and parents and grandparents don't get re-exposed to it. That used to act like a booster shot.
A vaccine for adults, approved in mid-2006, does the same thing, but very few people have had it. This may change with the CDC's recommendation that adults 60 and older get vaccinated.
Merck makes the vaccine, Zostavax. The company is funding some of Tyring's research in hopes the vaccine will be approved by the Food and Drug Administration for people in their 50s.
It will take several years to make that decision. Meanwhile, Viola Stover is lobbying her friends.
"I'm telling everyone to please, for God's sake, get the vaccine," she says. "Because if they don't, they will suffer!"
It's getting easier to obtain the vaccine. In the wake of the CDC recommendation, Medicare and private insurers are beginning to cover the shot, which costs about $160.