Rising Shingles Cases in Adults Put Unvaccinated Children at Risk

The death of a 30-year-old Texas man made headlines in July when he got infected with the coronavirus after attending a “Covid-19 party.” According to the chief medical officer at Methodist Hospital in San Antonio, the man said he attended a gathering with an infected person to test whether the coronavirus was real and to gain immunity from it.

This isn’t the first time Americans have signed up for intentional virus exposure in the hopes of achieving immunity. Before the chickenpox vaccine became available in 1995, many parents hosted “chickenpox parties” with similar infection and immunity goals for their children.

But at the time, parents may not have known that the same virus that causes chickenpox can re-emerge later in life as shingles — or herpes zoster. In addition to acute pain, fever and fatigue, more severe complications of shingles can include pneumonia, brain swelling (encephalitis), facial paralysis, hearing problems, permanent nerve damage or vision damage if the rash appears near the eye. Shingles can also reoccur.

I was 35 in the spring of 2019 when I noticed a shingles rash developing on my neck. The fiery pain soon became impossible to ignore, spreading across my shoulders and arms and into my fingertips. My doctor gave me an eight-day dose of antivirals and oxycodone for pain.

The chickenpox vaccine wasn’t available when I was a kid, so I asked whether a different vaccine could have prevented me from getting shingles in the first place. My doctor said yes, but that the vaccine for shingles, called Shingrix, was only approved by the Food and Drug Administration for adults over 50. Meanwhile, my son — who at the time had received one dose of the chickenpox vaccine but was too young to receive his 4-year-old booster shot — was at risk for developing chickenpox because he touched my shingles rash.

As I recovered from a monthlong battle with shingles, I began to research how the virus that causes it can affect adults. The more I learned, the more questions I had. Chickenpox and shingles vaccines are both highly effective, so why is the latter only available to older adults? How many young adults get shingles in the first place, and does the F.D.A. age recommendation for the Shingrix vaccine prevent them from getting it? And most importantly, do parents realize that unvaccinated kids — either because they are too young or by parental choice — might be at risk for chickenpox if they’re exposed to a shingles rash?

I spoke with experts to find some answers as well as some best practices.

Vaccinate your child early

According to a global survey of about 8,700 adults, only three percent reported knowing that the virus that causes chickenpox can also cause shingles.

Chickenpox — which typically causes a rash that turns into itchy, fluid-filled blisters and later fever, fatigue, headache and loss of appetite — typically resolves for most children within a week. But rarely and in high risk groups, it can lead to serious complications such as streptococcal infections, encephalitis, meningitis, stroke and death.

Before the vaccine, about four million people contracted the virus each year in the U.S.; more than 10,500 of those were hospitalized, and about 100 to 150 died.

All 50 states and the District of Columbia required children to receive two doses of the chickenpox vaccine before starting school; the first dose given around 12 months old, and the second between ages 4 and 6. That said, some parents may opt to vaccinate their children earlier, especially if a parent is experiencing a shingles episode.

“If the child has no immunization and is healthy, get their first shot right away,” said Dr. Anne Gershon, M.D., a pediatric infectious disease specialist and researcher at Columbia University’s Vagelos College of Physicians and Surgeons. There is also no need to wait until age 4 for a booster dose. “Give them the second shot early,” she said. “You could give it at 18 months.”

Dr. Gershon led the U.S. clinical trials in the early 1970s that first tested the chickenpox vaccine on 575 children with underlying leukemia. Researchers braced for potential side effects, but there were none. “After those data were published, people began to be interested in vaccinating healthy children,” she said.

Consider your risk factors for getting shingles

More than 95 percent of adults in the U.S. had chickenpox before age 18, and about one in three will develop shingles in their lifetime, according to the Centers for Disease Control and Prevention. Unfortunately, shingles cases in the U.S. have more than quadrupled between 1945 and 2007, even in younger adults.

“It does seem to be continuing to increase in a linear kind of way, without accelerating or decelerating, just a steady increase over time,” said Dr. Rafael Harpaz, M.D., a medical epidemiologist with the C.D.C.’s Division of Viral Diseases. The cause of the increase isn’t clear, but Dr. Harpaz noted that shingles is more prevalent in older adults and estimated that cases will likely continue to increase 2.5 percent per year for all ages, especially if they have a chronic illness that leads to a weakened immune system or a family history of shingles.

Dr. Harpaz said that while adults under 50 are getting shingles at a higher rate than previously reported, studying and tracking it is challenging because those who have milder symptoms might mistake them as symptoms of another ailment. Younger patients may never seek a shingles diagnosis or treatment, or (as in my case) not realize they are exposing their own child to the virus that causes it.

One thing is certain: If you had chickenpox as a child, you can get shingles as an adult. If you’re a parent and notice a painful rash, cover it with a bandage to prevent contact with your children and make an appointment with your doctor. Early treatment, Dr. Harpaz said, can lessen the side effects and the degree of contagiousness.

Consider the “off label” option

As with the 5 to 20 percent of people in the U.S. with shingles, I still experience burning nerve pain in my neck where the rash first appeared. And, like millions of other parents, I’m struggling to live a normal life while physical distancing and teaching my son remotely. My son needs a healthy mom now more than ever. As coronavirus cases rise, I worry about how I would fare against the disease and shingles. I also worry that coming down with Covid-19 might lead to a re-emergence of shingles.

There are some, albeit limited, hints that my concerns may be warranted. One article published in May by researchers in Egypt detailed the cases of two patients who suffered shingles episodes shortly before developing Covid-19 symptoms. A separate case observed by doctors from the University of Massachusetts’s Department of Emergency Medicine described a Covid-19 patient with coexisting shingles symptoms who developed meningitis-like symptoms, suggesting that these could be initial symptoms of Covid-19 in some patients that are “not the classic respiratory symptoms and fever.” But more work would be needed to confirm this.

Requesting the Shingrix vaccine outside of the F.D.A.’s age recommendations is an option for adults, according to Dr. Kathleen Dooling, M.D., a medical officer and liason to the C.D.C. advisory panel, Herpes Zoster Work Group. “It’s reasonable to talk to your physician about it, and together you can discuss whether you would want to take the next step to get the vaccine,” she said. “It’s what we would call ‘off label.’”

2020 has been a medical no-man’s land — a surreal landscape that has forced our culture to evaluate the importance of personal safety and self-advocacy like never before. I have an appointment to receive the Shingrix vaccine in a few weeks, which is covered (to my surprise) by my medical insurance. Given my age, it’s a choice the F.D.A. considers unnecessary. It’s also a choice that prioritizes my family’s health in an already uncertain future.

Sarah Szczypinski is a freelance journalist who writes about health, personal finance and parenting.