Shingles

Abstract

As part of an adult immunization program, the occupational and environmental health nurse should consider offering the shingles vaccine for employees aged 60 years and above.

Shingles, or herpes zoster (HZ), is a painful viral infection that affects nearly 1 million individuals each year in the United States (Reeves & Beuscher, 2015). The risk of developing shingles increases as individuals age with about half of all cases of shingles occurring in men and women above age 60.

Shingles is caused by the varicella zoster virus. Almost all individuals in the United States have the varicella zoster virus in their body either from having chickenpox or receiving the chickenpox vaccine, and are at risk for developing shingles. The varicella zoster virus remains dormant on dorsal horn nerve cells near the spinal column but becomes reactivated when the immune system is compromised by age, negative life events, diseases, medicines, or treatments (Reeves & Beuscher, 2015).

The first sign of shingles is burning or tingling pain in the skin. After several days or weeks, a rash of fluid-filled blisters appears on one area or on one side of the chest, abdomen, back, or around the face or eyes. The blisters typically scab over in 7 to 10 days and resolve within 2 to 4 weeks. The most common location for shingles is a “band, called a dermatome, spanning one side of the trunk around the waistline” (National Institute of Neurological Disorders and Stroke [NINDS], 2015, para. 1). Other symptoms can include numbness, itching, fever, fatigue, headache, chills, and upset stomach.

Early recognition of shingles is essential. The severity and duration of shingles can be reduced by treatment with antiviral drugs, such as acyclovir, valacyclovir, or famcyclovir (NINDS, 2015), when administered within 72 hours of when the rash appears. The antiviral drugs along with other medicines can treat or prevent postherpetic neuralgia (PHN), a common complication of shingles. The pain from PHN usually resolves in a few weeks or months in most individuals, but can persist for many years in some.

The Advisory Committee on Immunization Practices (ACIP) recommends a single dose of the shingles vaccine, Zostavax, for individuals age 60 years and older (Centers for Disease Control and Prevention [CDC], 2014). Although the Food and Drug Administration has approved Zostavax for adults age 50 and older, the CDC does not have a recommendation for routine use of shingles vaccine in people aged 50 through 59 years. Zostavax reduces the risk of developing shingles and the long-term pain that can follow.

As part of an adult immunization program, the occupational and environmental health nurse should consider offering the shingles vaccine for employees aged 60 years and above. The nurse is also instrumental in referring workers to their health care provider for early diagnosis and treatment of shingles. Most individuals have shingles on the trunk and limbs, which can be covered by clothing. Workers should remain out of work, however, if the rash is weeping and cannot be covered, such as on the face (Litchfield, 2010). The nurse should educate employees about not touching or scratching the rash, keeping the rash covered, and washing their hands frequently to prevent the spread of varicella zoster virus.