Talk:Shingles/Archive 3

Archive 1

Archive 2

Archive 3

reassessment

This page is undergoing a Good article reassessment. Snowman (talk) 10:37, 29 December 2007 (UTC)

Why does the milestones template at the top of this talk page indicate the result of the GAR is "keep"? --Una Smith (talk) 18:43, 9 January 2008 (UTC)

It was removed from GAR assessment temporarily until the FAR was completed, which was later the same day. There is some text preserved about this somewhere. I think that it would be better to record this as postponed rather than kept. Snowman (talk) 22:31, 9 January 2008 (UTC)

The previous GAR result was "keep", for procedural reasons. The current GAR will be listed as a new article history action once it is complete Geometry guy 17:39, 12 January 2008 (UTC)

Now added. The result was "delist". Geometry guy 19:24, 18 January 2008 (UTC)

Nerve cell bodies

My issue with "nerve cell bodies", apart from the vague terminology, is that it is irrelevant to Herpes zoster. Latent HZ has been shown to be integrated into the host cell DNA, in the cell nucleus. The location of the nucleus in the host cell does not matter and is at best a tangent. By the way, to me "nerve cell bodies" implies that the viral genome is latent not in the nucleus but rather outside the nucleus, in a restricted portion of the cytoplasm. That would be highly bizarre. Why not refer to "nerve cell nuclei" or "nerve cell DNA"? --Una Smith (talk) 06:23, 13 January 2008 (UTC)

Can you quote a reference for the HZV genome being incorporated in the host DNA? Preferably a reference on the web, because that would solve some of the problems here. Snowman (talk) 12:23, 13 January 2008 (UTC)

It sure would: nerve cell DNA is something that an educated general reader can understand. Geometry guy 18:03, 13 January 2008 (UTC)

I should not write late at night. VZV is a dsDNA virus, not a retrovirus. Make it "nerve cell nucleus" and you're home free. A ganglion is a node in a nerve. WP does not explain it well. Here is some text, with inline comments and a ref. --Una Smith (talk) 18:42, 13 January 2008 (UTC)

Some VZV genes are transcribed during latency; this transcription requires VZV DNA to be in a cellular compartment that has the machinery needed for transcription. Human nerve cells (neurons) have two kinds of compartment with this machinery: many mitochondria and a single cell nucleus. In situ hybridization detects VZV DNA only in the nucleus.

I think that this is getting down to the much-needed minute details needed to make the article easier to understand. I think that some of the references currently quoted on the article page do not refer to this in detail, so I was reluctant to write down what was not in a reference, especially as the article is under a microscope at the present time. To me, your suggestions sound good. Snowman (talk) 20:07, 13 January 2008 (UTC)

References

Immunization

In Canada, varicella immunization is given at 12 months of age as part of the routine immunization schedule.

Here's some references... http://www.phac-aspc.gc.ca/publicat/cig-gci/p03-01-eng.php

http://www.phac-aspc.gc.ca/publicat/cig-gci/p04-vari-eng.php

Would it be reasonable to add a short paragraph about this in the prevention section?

Pdrowemd (talk) 19:32, 26 March 2008 (UTC)

Please don't take this wrong, but Canada is kind of small, and it would make it unwieldy to add information for every country in the world. Moreover, I'm not sure what the varicella immunization has to do with Herpes zoster. I would suggest it could be in Varicella zoster article. OrangeMarlin ^{Talk• Contributions} 22:59, 26 March 2008 (UTC)

No problem. There is wide discussion about the effect of Varicella immunization on the incidence of Shingles. There is an idea that wide implementation of Varicella vaccination may lead to increased episodes of Shingles due to less subclinical exposure to the virus as adults. Probably best in the Varicella section though. Pdrowemd (talk) 00:26, 27 March 2008 (UTC)

I meant to say something slightly different. I meant to say, "varicella immunization of infants", because it wouldn't prevent shingles, except indirectly by preventing chickenpox. After helping write this article, I pulled a vial of varivax out of stock and immunized myself, since I had chickenpox as a kid. OrangeMarlin ^{Talk• Contributions} 01:13, 27 March 2008 (UTC)

Immunocompromised

I am struggling with the second line in the second introductory paragraph referring to an immunocompromised individual. Shingles can occur in otherwise healthy individuals with decreased disease specific cell-mediated immunity, and the onset of shingles would not trigger a search for occult immunosuppression such as with occult cancer. Perhaps we can add the phrase "or in an individual with a decrease in cell-mediated immunity".Pdrowemd (talk) 15:48, 27 March 2008 (UTC)

I think the sources state immunocompromised meaning anything from stress to AIDS. The problem with "cell mediated immunity" is that we're trying to write this for a college student, and that needs explanation. OrangeMarlin ^{Talk• Contributions} 21:40, 27 March 2008 (UTC)

True enough, although "cellular immunity" is commented on in the last section as well. My problem is with the term immunocompromised and how a layperson would interpret the term, although this may be better solved by editing that wiki-entry. I'll have a closer look at that entry.Pdrowemd (talk) 22:44, 27 March 2008 (UTC)

Diagnosis with PCR

Has anyone been able to confirm the numbers within the referenced article for the last paragraph in this section? I have been unable to confirm the stated 100% sensitivity and specificity. Also, the PPV and NPV seem more confusing than helpful to me, especially when we don't know the prevalence in the study.Pdrowemd (talk) 18:33, 27 March 2008 (UTC)

I'm not sure where that paragraph came from. I'm not sure intense language about the clinical trials for a diagnostic test has much value to the article, especially since visual determination during a differential diagnosis is about all that is used today, and it's pretty successful. I'd delete it. OrangeMarlin ^{Talk• Contributions} 21:43, 27 March 2008 (UTC)

Just a note that I agree with the edit that Animeita suggested for removing those two sentences. I still can't confirm their accuracy, and I think they are needlessly confusing. Maybe you could resubmit with an edit summary.Sisyphus (talk) 18:00, 28 March 2008 (UTC)

Playing with the lead

The first and second paras duplicated content somehwat so I am trying torejig it a bit. It is tricky considering what the scope of the article is...Cheers, Casliber (talk · contribs) 23:40, 27 March 2008 (UTC)

Adjusted your changes slightly. I like your semi-solon comment.Pdrowemd (talk) 00:53, 28 March 2008 (UTC)

PS: Further studies during the 1950s on immunosuppressed individuals showed that the disease was not as benign as once thought, and the search for various therapeutic and preventive measures began - would be better to be more specific here as the general idea of it being considered less benign as time goes on is conveyed in the previous few sentences. Cheers, Casliber (talk · contribs) 23:43, 27 March 2008 (UTC)

I thought we had topic banned you from any article that didn't have to do with fungi. Last time I checked zoster is not a fungus. I'm going to ArbCom.  :) Oh, we should be serious here. Thanks. OrangeMarlin ^{Talk• Contributions} 00:06, 28 March 2008 (UTC)

Epidemiology and Chickenpox

The second paragraph of the epidemiology section seems for appropriate for Chickenpox than Zoster, except for the first sentence. I would suggest it be deleted. Thoughts? Sisyphus (talk) 19:10, 28 March 2008 (UTC)

The first two sentences of that paragraph need to be removed, so I would partially agree with you. The problem is we have three overlapping articles: chickenpox, varicella zoster virus, and herpes zoster. There's a small conversation going on at Wikiproject Medicine about separating the disease from the virus. Maybe chickenpox and herpes zoster (or shingles) needs to be merged. OrangeMarlin ^{Talk• Contributions} 19:58, 28 March 2008 (UTC)

The more I think about it, the more I like the idea of merging these two topics. One's a natural extension of the other. By the way, I'm rapidly discovering the need to keep my language precise in the world of Wiki :) Sisyphus (talk) 05:26, 29 March 2008 (UTC)

(I've moved further comment on merging to the Wikipedia talk:WikiProject Medicine#Viruses and diseases discussion to keep things in one place. Colin°^Talk 08:59, 29 March 2008 (UTC))

Article cluster

For the record, the current article cluster relating to varicella zoster virus is:

• Varicella zoster virus
• Chickenpox
• Herpes zoster - rated GA
• Postherpetic neuralgia

Discussions of this cluster include:

• Wikipedia talk:WikiProject Medicine#Viruses and diseases

--Una Smith (talk) 20:30, 29 March 2008 (UTC)

Does adult exposure to a child with chicken pox increase the adults likely hood of having shingles? EG should grandparents avoid a child with chicken pox to avoid a shingles outbreak? 98.207.230.186 (talk) 22:56, 26 March 2009 (UTC)

Chickenpox causality

The article currently says Herpes zoster occurs only in people who have had chickenpox, which to me implies it does not occur in people who have had the vaccine. Chickenpox is a clinical diagnosis of infection, not infection per se. I suggest instead Herpes zoster occurs only in people who have been previously infected with VZV followed directly by an explanation of whether this includes or excludes people who have been vaccinated. --Una Smith (talk) 14:43, 30 March 2008 (UTC)

I agree that this needs to be changed. However, I don't believe it is known whether vaccination for varicella decreases your chances for developing shingles. The CDC and the manufacturer are quite careful not to make that claim. It is possible that patients immunized with Varicella vaccine could still develop Zoster. I wonder if the phrase should be Herpes Zoster occurs only in people who have been previously infected with VZV. This is typically individuals with clinical varicella (chickenpox), but may included individuals vaccinated with Varicella vaccine.Sisyphus (talk) 18:44, 30 March 2008 (UTC)

Oops, didn't see this before I edited - I removed the line "Herpes zoster occurs only in people who have had chickenpox," as it can also occur post-immunization - I concur with the line Herpes zoster occurs only in people who have been previously infected with VZV, so I'll add that - explanatory text about how this can happen is up to you, I'm not sure it's necessary. --Synaptophysin (talk) 20:02, 16 August 2011 (UTC)

--67.171.82.243 (talk) 15:04, 18 November 2010 (UTC)==Zoster== [[File:Example.jpg]] I am a 31yr old female with Shingles, who had chickenpox at 8yrs old. In all the material I've read about concerning Shingles, none mention someone getting Shingles before the age of 50 or 60. AAnd get this, I'm too young to get the vaccine anyway, how ironic. FOr me, It started as a knot along the mid right side of my spine and I put muscle rub on it and had my boyfriend rubbing it out, so I thought. 2 days later, I noticed bumps under my breast (along my bra line) and thought oh it might just be from sweating and wearing a tight sportsbra,but then I felt some of the worst pain in my life. And here I am putting cortizone on the breast rash and muscle rub on my back, until I noticed a welt-shaped mark on my back. Never thinking it could be SSHingles,I just took some pain meds and tried to sleep away the pain, but everytime I got up to brush teeth or hair or change clothes, I literally was crying due to the pain. I finally went to the doctor, who presribed me anti-viral meds and scripts for lidoderm patch and Lyrica, which both were to help with the pain. OF course, My Valtrex went through...no problem, but my insurance comp wouldn't approve it. Needed Prior AAuthorization (I literally hate that WORD now). So I still haven't gotten all my meds approved and it;s been about 8days since rash occured. I AM GOING TO GET THAT sHINGLES VACCINE SHOT, when I'm rash free. I heard that it can reduce my chance of getting it again by 50%, no matter If have to battle with my insurance comp about it. I haven't seen pictures of a person who has the rashes in the same places as me-right-side,underneath and along breast, then spots along my side and a 4in lesian on my back. I hope that My experience will help someone else feel that there're not alone in this.I'm sure there are people under 50 that have had Shingles; why isn't it reported. I know I'm not the only one under 50 with Shingles..ERIKA —Preceding unsigned comment added by 67.171.82.243 (talk) 14:25, 18 November 2010 (UTC)

I'm just a little older than you, Erika. It appears I've got it. My brother's had it recently so it seems possible I caught a strain of his, while the strain in my spine migrated outward. One strain must weaken you, while the other uses the chance to do more mischief than usual.

Pain began at the top of my left pectoral beginning almost a year ago when I first had contact with him. No rashes at the time. I suspect the virus that causes chicken pox causes a lot more complications than just chicken pox and shingles. It's probably a whole spectrum of ailments/symptoms and those two are just easily observable points along a continuum. The unique type of feverishness, night sweats, fatigue, headaches, and burning/stabbing pain I've experienced from time to time for a long time -- possibly since I first had chicken pox as a child -- just in varying amounts. Now that it’s gotten this bad suddenly, it’s not something I don’t recognize in its subtler forms. Varying amounts of these symptoms clump together at certain times when I'm stressed or have gotten over being sick previously. I've been under a lot of stress lately, so I think all these symptoms are finally appearing at once for the explicit "shingles" variant of all this.

Last week I had what appeared to be a small spider bite on that left pectoral muscle in exactly the spot I've had those stabbing pains before. But there were also a bunch of little bite-like lumps in my left arm pit, too. There's been varying mild stabbing pains, burning sensations, throbbing, and weird numbness across that swath, even if there is no rash between the spots. The pectoral "bite" developed a few other marks, but nothing too terrible and not as organized as the arm pit spot. The pectoral area began to itch really bad for a few days and then went back to the pin feeling. The armpit rash developed just a few short rough rows in a cluster and is not quite as highly organized and discrete as some of the wiki photos, but the spots themselves look identical. They've followed the same irritation pattern, as the itching has gradually turned into alternating burning and pins.

The most interesting issue is the hypersensitivity of my left arm. Not only is the area between the two rash spots also bothersome, but any excessive pressure on or rubbing of the aft arm or elbow causes further discomfort, such as a very annoying charlie horse like radiating burning and soreness, like I banged my elbow in that way. I didn't. The only other pains I have, besides the now only mild headaches, is some slight stabbings in my left side from time to time and discomfort on the left side of my neck. All in all, it could be a lot worse. I'd describe it as mild to moderate discomfort currently, with the past few prior days having been extreme on the annoyance end from the itching & burning, but not excruciating pain. I’ve been lucky.

I'm worried about little bumps and blisters I've previously had on the edge of my ear canal and around the eye in the past. To be clear, they’re not present now. But I don't think you can get zits in those places, and they didn't feel or look like pimples at the time... especially the one at the ear canal.

It appears from everything I've read, there is little evidence that any of these treatments actually prevent complications... aside from reducing the perception of pain and the severity/duration of the lesions, thus lowering the incident of suicide or car crashes from debilitating discomfort. I don't see any indication these treatments would be particularly useful for me, as my superficial symptoms are not that severe. But who knows. It could be causing motor, muscle, and neurological issues that would be hidden and there’s no way to determine if the damage is being done until there are outward problems as a result of them. Oh well. There are worse things in the world and being in your 30s having them is practically a luxury. This virus needs to be immunized against, though. It's at a point in medical history that there's no excuse for allowing people to get it anymore, especially considering the "mystery" surrounding how the virus moves around and affects the body. But don’t blame your parents, because before there was a vaccine the danger of getting chicken pox as an adult was very real. Ben 66.178.144.137 (talk) 08:24, 10 March 2011 (UTC)

Image suggestion

A very useful article - I was able to identify my Dad's rash as shingles and the emphasis on 72 hours meant he went straight to the doctor as soon as the rash appeared. With the diagram at Dermatome (anatomy), I was able to pin it down to L2 and the diagram was very helpful in demonstrating the reason the stripes are less horizontal it approaches the limbs and I was wondering if it would be a good idea to include File:Dermatoms.svg on this article too as, while the photographs are good and helpful, it was the dermatome diagram that helped make the penny drop. (Emperor (talk) 14:41, 2 March 2009 (UTC))

Shingles

I'm 23 yrs old with shingles. I asked a physician at a local pharmacy what the rash looked like; told me to put cortizone cream on it. BAD IDEA. I asked a plastic surgeon; told me it looked like shingles. I went to a family doctor and that was confirmed. I waited about a week before asking for help due to the fact the pain was becoming extreme. I thought it was a crazy spider bite or poison ivy of some sort. I have experienced both but I had no knowledge of herpes zoster aka. SHINGLES. I take good care of my body so I wonder how I could have sprung this other than stress...and if there is a possibility it may come back. The wikipedia article was very helpful and interesting to say the least. I just wish I knew if this is something that can come back. This has been painful and it worries me about the likely-hood of return. I have had mixed responses; so maybe Wikipedia can give others a definite...As well as myself.

-Thomas M. DeArmond —Preceding unsigned comment added by 98.215.69.39 (talk) 06:55, 28 April 2009 (UTC)

A physician at a local pharmacy is a bit on the unusual side. That one would go to a plastic surgeon before one's primary is a bit unusual as well. Indeed, to be honest, the first two are far more unusual than a 23 year old suffering from shingles by a fair bit.Wzrd1 (talk) 05:26, 12 November 2012 (UTC)

This is a solid article

Just wanted to say "good work, everyone." I got hit with shingles last week, after my doctor said that a weird tingling in my arm might have been its prelude. I found this article very useful in helping me self-diagnose once the rash appeared, encouraging me to go straight back and get onto that antiviral treatment.

Since then, I've been following along with this article as the disease has progressed, and I find it quite reassuring to have an idea when and how it will finally end. This article was also the first source (before even my doctor) to warn about the disease's contagiousness, which I would never have guessed. I've been keeping indoors, and so Wikipedia may have just helped prevent some other people from contracting nasty adult chicken pox.

Very solid article. jmac (talk) 18:43, 21 September 2010 (UTC)

Epidemiology

I am cleaning up the epidemiology section (there are some repeats and the writing doesn't flow very well). I am moving information on chickenpox epidemiology to the chickenpox article, because at the moment this is just confusing. Chopped sentences are below:

and has a very stable prevalence from generation to generation. VZV is a benign disease in a healthy child in developed countries. However, varicella can be lethal to individuals who are infected later in life or who have low immunity. The number of people in this high-risk group has increased, due to the HIV epidemic and the increase in immunosuppressive therapies. Infections of varicella in institutions such as hospitals are also a significant problem, especially in hospitals that care for these high-risk populations.

In temperate zones chickenpox is a disease of children, with most cases occurring during the winter and spring, most likely due to school contact; there is no evidence for regular epidemics. In the tropics chickenpox typically occurs among older people.

--Gak (talk) 11:00, 12 July 2011 (UTC)

References

spelling

Under "Antivirals" it's spelled acyclovir; in the section on the ophthalmic condition it's spelled aciclovir. Which is correct? Please change the other. If both are correct and refer to different drugs, please provide a link to each of the articles or put a separate explanation inside this article. 108.45.122.74 (talk) 11:51, 15 July 2012 (UTC)

They're both correct. The cited article for the paragraph uses "acyclovir", so we traditionally use the spelling of the citation. If you click on the wikilink for either acyclovir or aciclovir, it refers to the same drug. I believe one is the UK spelling, and one is the US spelling. I believe this article uses UK spelling, and aciclovir is the international usage, but some published articles, especially American ones use acyclovir for obvious reasons. SkepticalRaptor (talk) 16:19, 15 July

Prognosis/time to heal

Directly under prognosis, the article states that healing time for the rash and symptoms is 3-5 weeks, then two paragraphs later the article states that time to recover from H.Z. Is generally 2 weeks. This is a bit confusing and could use clarification. Does the system usually push the virus back into dormancy after 2 weeks, while symptoms persist for another week or more, or . . . ? — Preceding unsigned comment added by Jesse Heinig (talk • contribs) 00:32, 27 August 2012 (UTC)

Essentially, the body re-develops antibodies that have become sparse to the virus. That causes the virus "floating around" in interstitial fluids, the lymph and circulatory system to be removed by the immune system. That makes release from the infected cells rather "harmless". Then, the virus goes back to a dormant state. Once the lesions are scabbed over, the virus typically has been inactivated by the immune system and one is unable to transmit the virus to others. The rest is healing time and recovery time. Some never fully recover, due to neuralgia secondary to the re-infection by the dormant virus and ill understood causes.Wzrd1 (talk) 05:30, 12 November 2012 (UTC)

Neuroscience?

The top of this talk page states that this article is of Mid-Importance with regards to WikiProject Neuroscience. Unless I misunderstand, I'm not seeing that. This article has absolutely nothing to do with Neuroscience, and the classification should be removed. Spirit469 (talk) 11:53, 4 March 2013 (UTC)

It is a disease that infects neurons, and showws dermatomal patterns of rash. There's certainly a link to neuroscience. --Synaptophysin (talk) 14:41, 8 March 2013 (UTC)

Race/Ethnic origin in one of the references

Just saw that there was a change to ethnic descriptions to change "black" to "people of African descent" and "caucasian" to "people of European descent." On checking the references, the division in the article was into "black" and "white." People of African descent are not by definition black; African American is typically used for those of sub-Saharan African descent. I have changed the terms back to those used in the original study, as that is how the groups are described, and looking at the US Census, both "black" and "white" are acceptable (as is "African American," but not "people of African descent"). Is there a wiki policy on this? DO we simply stick with terms as used and operationally defined in the sourced article? To simplify matters I have quoted from the first article - the two references are referring to the same population, and one reads "black subjects were significantly less likely to develop zoster than were white subjects" while the second reads "After controlling for the above variables, blacks were significantly less likely to develop zoster." --Synaptophysin (talk) 14:41, 8 March 2013 (UTC)

Citation

This newly infected individual may then develop chickenpox, but will not immediately develop shingles. Until the rash has developed crusts, a person is extremely contagious. A person is not infectious before blisters appear, or during postherpetic neuralgia (pain after the rash is gone).[12]

Does not seem to be contained within the citation. Have marked accordingly. --LT910001 (talk) 05:29, 14 May 2014 (UTC)

Contagion from Zostavax Injection

Can this live vaccine cause disease in the injected person, and/or others? If there is a reaction at the injection site, can this be contagious to others? These are important questions for the relevant articles to adequately address. And most of the main ordinary sources seem to try to have it both ways. They do not report infections to anyone from the vaccine, but mention repeatedly that it is "live", and that there is some concern if there is a reaction at the injection site, and that such site reactions should be kept covered and that exposure to vulnerable others should be avoided -- out of a theoretical over-abundance of caution?

The Herpes_zoster#Prevention article seems better than the Zoster vaccine article.

sources review summary

• medicinenet.com

DOSING: Zoster vaccine is injected subcutaneously (under the skin) in the upper arm. The recommended dose is 0.65 ml.

Transmission of VZV virus from vaccinated individuals to other individuals occurs rarely.

The most apt discussion, but not authoritative:

• ask-curtis.com/shingles-vaccine-can-i-be-around-a-pregnant-woman/
• ask-curtis.com/how-long-am-i-contagious-after-shingles-vaccine/

Summary: Zostavax (the Shingles vaccine) is a live attenuated vaccine. Because of this there is concern that after you get vaccinated you should avoid contact with people who have weakened immune systems. If you tolerated the vaccine well and have no outward signs of illness it’s probably OK to be around people within seven days of the shot.

The fact of the matter is that a lot of the concerns about Zostavax infecting others is based on after market reporting. That’s because no drug company is purposely going to look at whether a drug will cause harm to pregnant women, HIV patients, cancer patients or the elderly.

Probably the best advice is to avoid high risk populations, even if you feel fine, for 7 days. If you still feel fine that far out it’s highly unlikely that you would pose much of a risk to anyone.

• vaccines.mil -- most helpful/informative authoritative source

Zostavax is a single-dose, sterile, preservative-free, live, attenuated vaccine manufactured by Merck & Co.

Each dose of Zostavax contains a minimum of 19,400 plaque-forming units (PFU) of the Oka/Merck strain of varicella-zoster virus (VZV) at expiry. The same manufacturing process used for Zostavax is used to manufacture Varivax, the vaccine for the prevention of chickenpox, with the exception that Zostavax contains higher amounts of the attenuated Oka/Merck vaccine virus in order to elicit an appropriate immune response.

5. Can the vaccine cause chickenpox?

Because this vaccine is made from a live, but weakened virus, about 1% of recipients develop a mild form of the disease, consisting of a limited rash, most often with only 5-6 blisters. Usually there is no fever. These people are then protected from the more serious, naturally occurring form of the virus.

6. Can the vaccine cause shingles?

Yes. However, a study conducted among children with leukemia determined that after receiving the vaccine these children were much less likely to develop shingles than children who had prior natural chickenpox. Available information from healthy children and adults suggest that shingles is less common in vaccinated healthy people compared with people who have had natural chickenpox.

• cdc.gov says:

No serious problems have been identified with shingles vaccine.

The vaccine has been tested in about 20,000 people aged 60 years old and older. The most common side effects in people who got the vaccine were redness, soreness, swelling or itching at the shot site, and headache. CDC, working with the FDA, will continue to monitor the safety of the vaccine after it is in general use.

It is safe to be around infants and young children, pregnant women, or people with weakened immune systems after you get the shingles vaccine. There is no documentation of a person getting chickenpox from someone who has received the shingles vaccine (which contains varicella zoster virus).

Some people who get the shingles vaccine will develop a chickenpox-like rash near the place where they were vaccinated. As a precaution, this rash should be covered until it disappears.

• fda.gov has minimal useful informaion:

Also, people who are in close contact with pregnant women who have not had chickenpox should talk to their healthcare provider to decide if using Zostavax is right for them.

• zostavax.com has this carefully worded vague warning:

ZOSTAVAX (Zoster Vaccine Live) contains a weakened chickenpox virus. Tell your health care professional if you will be in close contact with newborn infants, someone who may be pregnant and has not had chickenpox or been vaccinated against chickenpox, or someone who has problems with their immune system. Your health care professional can tell you what situations you may need to avoid.

• rxlist.com:

Caution is advised if you have regular close contact with family/household members with weakened immune systems (e.g., due to cancer) or who may be pregnant. It is not known if infection may occur from close contact with someone who has received this vaccine. Consult your doctor for more details.

-96.233.20.129 (talk) 19:21, 16 October 2014 (UTC)

Assessment comment

The comment(s) below were originally left at Talk:Shingles/Comments, and are posted here for posterity. Following several discussions in past years, these subpages are now deprecated. The comments may be irrelevant or outdated; if so, please feel free to remove this section.

Would someone please create a better diagram/image/picture? I'm not knowledgeable enough to DO it, but I am knowledgeable enough to figure out that it's anatomically just plain silly. shortycat209.121.212.136 19:21, 8 September 2007 (UTC)

Last edited at 15:11, 7 July 2015 (UTC). Substituted at 15:47, 1 May 2016 (UTC)

Added text

Added public domain text from http://www.ninds.nih.gov/health_and_medical/disorders/shingles_doc.htm — Preceding unsigned comment added by 213.253.39.89 (talk) 05:03, 5 August 2002 (UTC)

Merge Disseminated herpes zoster over here

Any cons? Fgnievinski (talk) 04:02, 5 July 2015 (UTC)

Good idea. Doc James (talk · contribs · email) 04:34, 5 July 2015 (UTC)

yep! Jytdog (talk) 04:47, 5 July 2015 (UTC)

Contagious?

I still feel the line in the lead about the vesicular fluid being capable of causing chicken pox in someone who is not a host to the virus needs to be clarified further. My understanding is that it is possible to transmit the virus in this manner, and potentially years later after the latent infection the other individual could still go on to develop shingles, just like anyone else infected with the virus. Matthew Ferguson (talk) 05:41, 5 July 2015 (UTC)

How about "Exposure to the virus in the blisters can cause chickenpox in someone who has not had it before but it will not trigger shingles" Doc James (talk · contribs · email) 08:37, 5 July 2015 (UTC)

Since I posted this Fgnievinski has ammended the wording and I think it's more precise now. Matthew Ferguson (talk) 08:46, 5 July 2015 (UTC)

Primary name

1. I'd like to replace occurrences of the word "shingles" in the body of the article for the article title, would that be OK? Fgnievinski (talk) 03:13, 5 July 2015 (UTC)

2. ICD-10 seems to favor just "zoster" instead of "herpes zoster" [1] -- would you agree to rename the article accordingly, moving it over its redirect at zoster? Fgnievinski (talk) 03:13, 5 July 2015 (UTC)

Shingles is the more common name. Maybe we should move the article to shingles? We are trying to write for a more general audience and the word shingles will not be confused with any other medical condition that I know off. Doc James (talk · contribs · email)

I think the article name is no big deal - Shingles redirects here, and the first line makes it clear that Shingles is one of the names. But if it comes to a !vote, I would support a move to Shingles. In the body of the article, I do think we should refer to "shingles" instead of "zoster" or "herpes zoster" for sure, as that is the more common name among the public. Jytdog (talk) 03:46, 5 July 2015 (UTC)

I went ahead with uniforming usage to "shingles" instead of mixed shingles/herpes zoster/zoster. Can we now possibly rename the article, too? Also not sure if we want to harmonize zoster vaccine and disseminated herpes zoster and Herpes zoster ophthalmicus. Thanks. Fgnievinski (talk) 04:48, 5 July 2015 (UTC)

Encourage you to find out which is the more commonly used term in high quality medical sources. Matthew Ferguson (talk) 05:36, 5 July 2015 (UTC)

@Matthew Ferguson 57: Based on the sources cited in the present article, it's "herpes zoster". But I'm with the impression that in WP common names trump medical names, hence the change. Fgnievinski (talk) 05:41, 5 July 2015 (UTC)

This issue comes up often, whether we should name medical articles according to common name or according to MEDMOS, which is worded roughly as I described above. Matthew Ferguson (talk) 05:43, 5 July 2015 (UTC)

probably according to MEDMOS is best--Ozzie10aaaa (talk) 10:02, 5 July 2015 (UTC)

Yes we need to try to match the literature.

We should use the common name when possible / reasonable

It is known as zoster ophthalmicus rather than shingles ophthalmicus. I guess we could go with shingles of the eye?

Doc James (talk · contribs · email) 16:32, 5 July 2015 (UTC)

Zoster ophthalmicus is used in the literature, although I sense nowadays this is getting less commonly used. Not heard term shingles ophthalmicus before. Also zoster of the eye no good imo because it is not a precise equivalent of what we are trying to describe, I.e. involvement of the ophthalmic division of the trigeminal nerve. This might cause the lesions over the whole dermatome not just eye. Matthew Ferguson (talk) 06:56, 6 July 2015 (UTC)

I'd rather see this article WP:MOVEd to Shingles, but it's complicated because of Roof shingles and Shingle (disambiguation). When a common name is truly common (e.g., not narrowly regional), suitably formal in tone (e.g., not poop) and not ambiguous (e.g., not heart attack), then I'd rather have the common name. If normal, non-professional people are looking for information about Shingles, then I want them to know that they're definitely on the right page. WhatamIdoing (talk) 18:29, 5 July 2015 (UTC)

Yes agree. Shingles already redirects here so not to big of a deal to move it.Doc James (talk · contribs · email) 05:59, 6 July 2015 (UTC)

@WhatamIdoing:: As shingles redirects here, not to Shingle (disambiguation), do you see any problem in moving herpes zoster to shingles? I'm about to request that technical move if there is no opposition. Thanks. Fgnievinski (talk) 19:15, 6 July 2015 (UTC)

I have no objection. I do have some curiosity about whether any articles about architecture or building supplies accidentally redirect here. WhatamIdoing (talk) 00:39, 7 July 2015 (UTC)

Update: I have satisfied my curiosity, and fixed a dozen or so, all of which needed to link to roof shingle instead. WhatamIdoing (talk) 00:57, 7 July 2015 (UTC)

Oral involvement

Extended content

The trigeminal nerve is the most commonly involved nerve, accounting for 18-22% of shingles cases. The ophthalmic division of the trigeminal nerve is most commonly involved branch (zoster ophthalmicus). Shingles may occur in the mouth if the maxillary or mandibular division of the trigemenial nerve is affected, in which the rash may appear on the mucous membrane of the upper jaw (usually the palate, sometimes the gums of the upper teeth) or the lower jaw (tongue or gums of the lower teeth) respectively. Oral involvement may occur alone or in combination with a rash on the skin over the cutaneous distribution of the same trigemnial branch. As with shingles of the skin, the lesions tend to only involve one side, distinguishing it from other oral blistering conditions. In the mouth, shingles appears initially as 1-4 mm opaque blisters (vesicles), which break down quickly to leave ulcers that heal within 10-14 days. The prodromal pain (before the rash) may be confused with toothache. Sometimes this leads to unnecessary dental treatment. Post herpetic neuralgia uncommonly is associated with shingles in the mouth. Unusual complications may occur with intra-oral shingles that are not seen elsewhere. Due the close realtionship of blood vessels to nerves, the virus can easily spread to involve the blood vessels and compromise the blood supply, sometimes causing ischemic necrosis. Therefore, oral involovment rarely causes complications such as osteonecrosis, tooth loss, periodontitis (gum disease), pulp calcification, pulp necrosis, periapical lesions and tooth developmental anomalies.

We now may contradict ourselves. "Zoster ophthalmicus involves the orbit of the eye and occurs in approximately 10% to 25% of cases." and "The trigeminal nerve is the most commonly involved nerve, accounting for 18-22% of shingles cases.[19]" — Preceding unsigned comment added by Doc James (talk • contribs) 16:27, 5 July 2015 (UTC)

hmm. Well we could decide which source is more reliable. 10-25% is supported by a 2002 Am Fam Physician review which gets these figures from a 1982 primary source. The 18-22% figure comes from a 2015 case report and review of lit from Indian journal of dental research which quotes two other scase report and review of lit from 2009 and 2010. We also have this textbook (ref 2 above) which says trigeminal involvment accounts for 15% of all cases. Matthew Ferguson (talk) 02:58, 7 July 2015 (UTC)

We also have this review which says trgeminal zoster is 10-15%.

References

--Matthew Ferguson (talk) 06:28, 7 July 2015 (UTC)

Merge herpes zoster ophthalmicus here too?

This article could be condensed a lot since there is a lot of repetition. Matthew Ferguson (talk) 06:52, 7 July 2015 (UTC)

That's a good idea, although I wouldn't know what could be safely discarded and what should be kept. Fgnievinski (talk) 13:07, 7 July 2015 (UTC)

Intravenous Vitamin C for zoster?

There are a few old (but apparently unrefuted) studies on the efficacy of intravenous vitamin C for treatment of zoster. Before I go down that path, I'd like some corroboration from medical editors. Vitamins for treatment of anything seem to be eschewed in wikipedia. Sbalfour (talk) 18:51, 22 November 2016 (UTC)

Content is limited by what sources that comply with WP:MEDRS say. Jytdog (talk) 20:09, 22 November 2016 (UTC)

Herpes Zoster Oticus and Ramsey Hunt Syndrome

We should mention these here somewhere parallel to HV Ophthalmicus. RHS is not quite synonymous with HZO, as RHS implies involvement of the facial nerve in addition to the auditory nerve. Neither manifests until or unless you've already had chickenpox, so they're properly variants or complications of shingles.Sbalfour (talk) 19:58, 22 November 2016 (UTC)

Yup with a good ref should be added. Doc James (talk · contribs · email) 23:33, 23 November 2016 (UTC)

Prevention

Does anyone have statistics about people developing shingles from having full-blown out break of Chickenpox vs. being vaccinated? It would be interesting to see if the inert Varicella-zoster virus vaccination reduced the occurrence of Shingles. If so then this method of shingle prevention is copyrighted by me --Supercoop 16:01, 2004 Oct 13 (UTC) and released to the community under GFDL. :)

The Prevention section currently only talks about vaccines and doesn't mention if e.g., staying away or not touching other people with the disease will help. Or not sharing toothbrushes, etc. Jidanni (talk) 15:03, 28 September 2017 (UTC)

Clarification re contagious status of shingles

Doc James, I recently made an edit to the lead which was reverted. Probably agree this into does not need to be in lead, however seems that shingles could in theory be considered contagious as it could be passed to someone who has not had the primary infection of chicken pox, who then eventually may go on to do have their own reactivation of the virus in later years. Matthew Ferguson (talk) 00:14, 22 February 2017 (UTC)

Exposure to the virus in the blisters can cause chickenpox but it does not trigger shingles at any point in time. True once a person has chickenpox they can latter have shingles but that would not be a "delayed triggering". We already mention that only 50% of people develop shingles thus IMO "and not all who have had chicken pox will later develop shingles" is not also needed. Doc James (talk · contribs · email) 10:47, 22 February 2017 (UTC)

Fair enough. Matthew Ferguson (talk) 20:48, 22 February 2017 (UTC)

Doc James Did you mean to restore the part about the vaccine effectiveness as well at the part about outbreaks? Also, how does a shingles outbreak occur? I suppose a case of shingles could start a chickenpox outbreak, but I think this should be clarified. Tornado chaser (talk) 02:01, 7 November 2017 (UTC)

Outbreak

When shingles occurs it is often described as an outbreak.[2] Doc James (talk · contribs · email) 01:57, 7 November 2017 (UTC)

@Doc James:I don't have access to source you provide, but are you referring to "outbreak" like "my skin broke out with a rash" or in the epidemiological sense? Tornado chaser (talk) 02:07, 7 November 2017 (UTC)

Waiting on a proper review to come out regarding the new vaccine. Should come out soon I image.

It is an outbreak of blisters on a single person rather than a community outbreak. This is fairly common usage with respect to shingles. I have clarified that. Doc James (talk · contribs · email) 15:12, 7 November 2017 (UTC)

New Non-live Vaccine Approved for Shingles

It would be informative to include in the article the fact that a new non-live vaccine was approved on October 20, 2017. Non-live and 90% efficacy rate are definite advances and are certainly worth adding to the body of knowledge of the subject. (For purposes of research, the name of the drug is Shingrix. I discovered it on the New Drug Approvals page of the Drugs.com website.)

47.140.159.26 (talk) 22:37, 10 November 2017 (UTC)Monica DiFranco

Yes article already discussed it. Have clarified things a bit. Doc James (talk · contribs · email) 07:32, 11 November 2017 (UTC)