Post by Nadica (She/Her) on Aug 2, 2024 21:48:07 GMT
Shingles cases are increasing in New South Wales. Experts say COVID might be why - Published Mar 20, 2024
Out of everything Regina Featherstone remembers about shingles, it's the nerve pain that stands out.
"I would take one step … the pain sears up," she recollected.
In December 2022, the 31-year-old developed shingles on her scalp and face, a time when she was both rundown and exhausted.
Initially, it was a small red lump on Ms Featherstone's neck, something she thought was an infected hair follicle. Her GP agreed with her assumption — shingles is more often seen in older people. So, Ms Featherstone was prescribed antibiotics.
Since its spread more than four years ago, questions have been raised about how COVID interacts with the human body.
From how it interacts with the brain and lungs to long-term side effects, scientists have managed to answer some questions but are grappling with others.
One emerging question is whether COVID can increase the chance of shingles.
In 2022, a paper published by Oxford University Press reported that COVID was linked to an increased risk of shingles in patients over 50.
Coincidentally, some data suggests shingles cases have increased across age groups in parts of the country since 2020.
Ms Featherstone also said that, since her experience, she had become aware of other cases from those around her.
"I think that GPs would all agree that we've probably seen more cases of shingles over the last period of time over COVID," Charlotte Hespe, a GP and professor of general practice at The University of Notre Dame, told the ABC.
"Absolutely, shingles is an illness that, theoretically and I think in practical reality, has been increased through COVID-19."
What is shingles?
Shingles is a re-emergence of varicella-zoster virus, the same virus behind chickenpox.
Once our bodies recover from a bout of chickenpox, this virus remains in our body.
"After the chickenpox virus circulates in our body, it lodges in a small cluster of nerve cells, next to the spinal cord," Tony Cunningham, director of Westmead Institute's Centre for Virus Research, said.
But, potentially at some point, even decades later, Professor Cunningham said the virus may move on from that cluster, along the nerves, to the skin, resulting in a painful "rash of lumpy, red appearance with bubbling of the skin later on" somewhere along the body.
The experience typically lasts between two to three weeks, beginning as a red rash, and affects roughly one in three people.
Most people will only have a case of shingles once in their life, with the condition being more common in those aged 60 years old and over. But, in small cases, around one in every 10, pain can last more than 90 days, otherwise known as postherpetic neuralgia.
"This can be really distressing because these pains, both the initial pain and the prolonged pain, are really very severe, can cause depression and impaired quality of life," Professor Cunningham said.
Shingles typically appears on the torso, but it can appear anywhere on the body, including the face.
There is no cure for shingles, but treatments exist. Antiviral medications can address symptoms and durations, but dosage must begin within 72 hours of the initial appearance of shingles.
Since November 2023, the Shingrix vaccine has been included in the National Immunisation Program (NIP) for certain cohorts, including those aged 65 years and over and immunocompromised people over 18 years old.
What is the possible COVID link?
While an infection of the COVID virus does not cause shingles, a potential connection between the two is emerging.
In NSW, there were 3,705 visits to emergency rooms linked with shingles in 2019. In 2023, that figure was 4,305.
Professor Cunningham said it was not clear whether there was a connection between shingles and COVID, with more research needed.
But, pointing to the 2022 study of COVID patients being 15 per cent more likely to develop shingles, he said an explanation could be the immune system.
One factor for an increased likelihood of shingles is reduced function of the immune system, the same reason why shingles is more common in older people, Professor Cunningham said.
Separately, one side effect of COVID can also be reduced function of our immune system.
"We do know that COVID can disturb immunity, particularly the severe causes where you can get variable responses to COVID," Professor Cunningham said.
"That would be my best bet in the absence of clear evidence."
But there could be alternative explanations, including the fact that shingles rates have been increasing in parts of the world for decades — something Professor Cunningham said wasn't understood but potentially linked to an aging population and better reporting on shingles.
"I think this [connection between COVID and shingles] needs further study. There's no doubt about it."
'It's you needing to be stressed'
Another working theory behind COVID's link is more indirect.
For Professor Hespe, one explanation for the rise in cases is from stress.
"We know it's you needing to be stressed that triggers [shingles] in one way or another," she said.
"That stress could be a huge range of different things from psychological stress through to an actual illness and or medication. That decreases your immune response to things."
Professor Hespe said one cause of stress could be from COVID and the pandemic at large.
In 2022, the World Health Organization said that social isolation and infection fears of COVID contributed to a global 25 per cent increase in anxiety.
Others agree that stress could be the explanation.
RACGP NSW and ACT chair and GP Dr Rebekah Hoffman said that we know shingles "can be linked to stressful times in people's lives" and COVID infections and outbreaks are "definitely a stressful time in someone's life".
"When your body is then a little bit rundown, [when] your cortisol is high, stress levels are high, you're going to be more susceptible then to a reactivation of the shingles virus," Dr Hoffman said.
"And that's what we find happens."
Out of everything Regina Featherstone remembers about shingles, it's the nerve pain that stands out.
"I would take one step … the pain sears up," she recollected.
In December 2022, the 31-year-old developed shingles on her scalp and face, a time when she was both rundown and exhausted.
Initially, it was a small red lump on Ms Featherstone's neck, something she thought was an infected hair follicle. Her GP agreed with her assumption — shingles is more often seen in older people. So, Ms Featherstone was prescribed antibiotics.
Since its spread more than four years ago, questions have been raised about how COVID interacts with the human body.
From how it interacts with the brain and lungs to long-term side effects, scientists have managed to answer some questions but are grappling with others.
One emerging question is whether COVID can increase the chance of shingles.
In 2022, a paper published by Oxford University Press reported that COVID was linked to an increased risk of shingles in patients over 50.
Coincidentally, some data suggests shingles cases have increased across age groups in parts of the country since 2020.
Ms Featherstone also said that, since her experience, she had become aware of other cases from those around her.
"I think that GPs would all agree that we've probably seen more cases of shingles over the last period of time over COVID," Charlotte Hespe, a GP and professor of general practice at The University of Notre Dame, told the ABC.
"Absolutely, shingles is an illness that, theoretically and I think in practical reality, has been increased through COVID-19."
What is shingles?
Shingles is a re-emergence of varicella-zoster virus, the same virus behind chickenpox.
Once our bodies recover from a bout of chickenpox, this virus remains in our body.
"After the chickenpox virus circulates in our body, it lodges in a small cluster of nerve cells, next to the spinal cord," Tony Cunningham, director of Westmead Institute's Centre for Virus Research, said.
But, potentially at some point, even decades later, Professor Cunningham said the virus may move on from that cluster, along the nerves, to the skin, resulting in a painful "rash of lumpy, red appearance with bubbling of the skin later on" somewhere along the body.
The experience typically lasts between two to three weeks, beginning as a red rash, and affects roughly one in three people.
Most people will only have a case of shingles once in their life, with the condition being more common in those aged 60 years old and over. But, in small cases, around one in every 10, pain can last more than 90 days, otherwise known as postherpetic neuralgia.
"This can be really distressing because these pains, both the initial pain and the prolonged pain, are really very severe, can cause depression and impaired quality of life," Professor Cunningham said.
Shingles typically appears on the torso, but it can appear anywhere on the body, including the face.
There is no cure for shingles, but treatments exist. Antiviral medications can address symptoms and durations, but dosage must begin within 72 hours of the initial appearance of shingles.
Since November 2023, the Shingrix vaccine has been included in the National Immunisation Program (NIP) for certain cohorts, including those aged 65 years and over and immunocompromised people over 18 years old.
What is the possible COVID link?
While an infection of the COVID virus does not cause shingles, a potential connection between the two is emerging.
In NSW, there were 3,705 visits to emergency rooms linked with shingles in 2019. In 2023, that figure was 4,305.
Professor Cunningham said it was not clear whether there was a connection between shingles and COVID, with more research needed.
But, pointing to the 2022 study of COVID patients being 15 per cent more likely to develop shingles, he said an explanation could be the immune system.
One factor for an increased likelihood of shingles is reduced function of the immune system, the same reason why shingles is more common in older people, Professor Cunningham said.
Separately, one side effect of COVID can also be reduced function of our immune system.
"We do know that COVID can disturb immunity, particularly the severe causes where you can get variable responses to COVID," Professor Cunningham said.
"That would be my best bet in the absence of clear evidence."
But there could be alternative explanations, including the fact that shingles rates have been increasing in parts of the world for decades — something Professor Cunningham said wasn't understood but potentially linked to an aging population and better reporting on shingles.
"I think this [connection between COVID and shingles] needs further study. There's no doubt about it."
'It's you needing to be stressed'
Another working theory behind COVID's link is more indirect.
For Professor Hespe, one explanation for the rise in cases is from stress.
"We know it's you needing to be stressed that triggers [shingles] in one way or another," she said.
"That stress could be a huge range of different things from psychological stress through to an actual illness and or medication. That decreases your immune response to things."
Professor Hespe said one cause of stress could be from COVID and the pandemic at large.
In 2022, the World Health Organization said that social isolation and infection fears of COVID contributed to a global 25 per cent increase in anxiety.
Others agree that stress could be the explanation.
RACGP NSW and ACT chair and GP Dr Rebekah Hoffman said that we know shingles "can be linked to stressful times in people's lives" and COVID infections and outbreaks are "definitely a stressful time in someone's life".
"When your body is then a little bit rundown, [when] your cortisol is high, stress levels are high, you're going to be more susceptible then to a reactivation of the shingles virus," Dr Hoffman said.
"And that's what we find happens."