As the prevalence of shingles continues to rise, particularly among middle-aged and elderly individuals, public health officials are taking significant steps to combat the virus. Starting in the spring of 2025, a shingles vaccine will be available as a routine, publicly funded vaccination for those aged 65 and older. This initiative aims to address the increasing number of shingles cases, which are caused by the varicella-zoster virus, the same virus responsible for chickenpox.
Shimizu Hiroki, head of the clinical laboratory department at Fujisawa City Hospital in Kanagawa Prefecture, highlighted the importance of understanding shingles and its implications. He noted that shingles manifests as a painful rash, typically appearing in a band or strip on one side of the body. This rash can lead to postherpetic neuralgia, a condition where pain persists long after the rash has healed, significantly impacting quality of life.
During an interview, Shimizu explained the contagious nature of the varicella-zoster virus. "During chickenpox infection, one patient can infect approximately 8 to 10 people, and it can also spread through the air," he said. This level of contagion is notably higher than that seen with other viruses like influenza and the novel coronavirus, which typically infect about 2 to 3 people. However, when it comes to shingles, the amount of virus present is less compared to chickenpox, making it unlikely to infect others unless the rash is directly touched.
Shimizu further elaborated that airborne infection does not occur with shingles. Nevertheless, individuals with significantly weakened immune systems due to medications such as anticancer drugs or steroids are at a higher risk of the virus proliferating. In such cases, the condition can escalate to disseminated shingles, which increases the risk of infecting others.
As a preventive measure, Shimizu emphasized the importance of vaccination. The chickenpox vaccine, introduced as a routine, publicly funded vaccination in October 2014, requires two doses administered between the ages of 1 and 3. This initiative has significantly reduced the incidence of chickenpox and, consequently, shingles. However, for those who have not been vaccinated or infected, the risk remains.
Shimizu noted, "Those who have not been vaccinated against chickenpox should receive two doses." He also pointed out that managing stress and ensuring adequate sleep are crucial in preventing shingles, as these factors can contribute to a weakened immune response.
In a related discussion, the article also shed light on Ramsay Hunt syndrome, a severe variation of shingles that can cause intense pain and neurological complications. Former Yokohama Mayor Fumiko Hayashi suffered from this condition and described her experience, stating, "I felt like a pencil was stabbed into my left ear." Her hospitalization lasted about a month, and she experienced symptoms including facial nerve paralysis and dizziness.
Ramsay Hunt syndrome affects about 1% of shingles patients, making it a rare but serious condition. The annual incidence rate of shingles ranges from 300 to 500 cases per 100,000 population, with one-fourth of these cases occurring in the trigeminal nerve area, which affects the face. Hayashi's case was particularly notable as it combined both trigeminal nerve area shingles and Ramsay Hunt syndrome.
Notable figures like Justin Bieber and musician Ryuichi Sakamoto have also been diagnosed with Ramsay Hunt syndrome, underscoring that this condition can affect anyone, regardless of age or gender. For shingles, individuals are typically advised to consult a dermatologist, while those experiencing Ramsay Hunt syndrome should seek care from an otolaryngologist.
Shingles can also lead to complications such as corneal ulcers and vision loss if the eye area is affected. Therefore, it is advisable for patients with facial involvement to see an ophthalmologist to prevent such serious outcomes.
Postherpetic neuralgia, a challenging aftereffect of shingles, can cause persistent nerve pain long after the rash has healed. Common painkillers often prove ineffective, necessitating the use of stronger medications, including narcotics. Shimizu noted, "What is troublesome is that the pain is severe, and treatment is very difficult. Ordinary painkillers do not work, so we often use medical narcotics, but even then, sufficient pain relief may not be achieved."
Those at higher risk for developing postherpetic neuralgia include the elderly, individuals with severe shingles symptoms, and those with weakened immune systems. While the condition is not life-threatening, it can greatly diminish one's quality of life.
As of April 1, 2025, shingles has been designated as a target disease for routine vaccination (Category B disease). This means that individuals turning 65 in fiscal year 2025, as well as those aged 60 to 64 with impaired immune function due to HIV, will be eligible for publicly subsidized vaccinations. To avoid overwhelming demand and potential shortages, eligibility will be limited each year to those reaching specific ages, including 65, 70, 75, 80, 85, 90, 95, and 100. Those aged 101 and older will only be eligible in fiscal year 2025 and will be excluded in subsequent years.
In summary, the introduction of the shingles vaccine as a routine public health measure represents a proactive approach to reducing the incidence of this painful condition. As awareness grows and preventive measures become more accessible, it is hoped that the burden of shingles, along with its complications, will diminish significantly in the coming years.
