Local actor Nick Shen recently shared on social media the weeks of pain he suffered when he had shingles. Part of his face was paralysed and he was hospitalised for five days. The Straits Times looks at how common this disease is, and asks experts how people can protect themselves against it.

Q: What is shingles?

A: Shingles is an infection caused by the varicella-zoster virus, which also causes chicken pox.

It manifests as a painful and itchy rash, usually on one side of the body or face. The rash, made up of small blisters, usually scabs up in a week. For most people, an attack of shingles clears up in two to four weeks.

Associate Professor Lim Poh Lian, head of Tan Tock Seng Hospital’s (TTSH) Travellers’ Health and Vaccination Clinic, said shingles, also known as herpes zoster, usually affects a patch of skin linked to a cluster of nerves.

“This gives an appearance almost like a snake wrapping around the body, which gives rise to its name in Chinese (which translates to ‘growing snake’), and herpes in Latin refers to a ‘creeping eruption’,” she said.

According to the United States’ Centres for Disease Control and Prevention (CDC), shingles can cause complications for up to one in five people.

The most common is long-term nerve pain. Other complications include pneumonia, encephalitis (inflammation of the brain) and hearing loss.

The risk of complications is higher in older people.

Q: Who is at risk of getting shingles?

A: Shingles occurs only in people who have had a prior chicken pox infection. This is because the virus, which remains dormant in their bodies, can reactivate and cause shingles.

Prof Lim said people who have never had chicken pox do not develop shingles.

About 80 to 85 per cent of adults here would have had chicken pox, she noted. It is not a reportable disease, but “the rates of shingles increase with those 50 years and older, rising more steeply after 60 years of age”.

Someone who has never had chicken pox can catch the infection through direct contact with the fluid from shingles rash blisters, or even from breathing in virus particles shed by the blisters. They will contract chicken pox and not shingles, though this infection would then put them at risk of getting shingles in the future.

The US CDC says that one in three adults will get shingles in their lifetime.

Dr Asok Kurup, an infectious diseases expert in private practice, said Singapore is estimated to have about 30,000 new shingles cases a year.

He said: “With increasing age, the risk of getting shingles increases due to declining immunity, with increasing rates seen in individuals over the age of 50. People with immunocompromised conditions below the age of 50 may also be at increased risk.”

Singapore included the varicella (or chicken pox) vaccine in the National Childhood Immunisation Programme in 2020. The two doses are given at the ages of 12 and 15 months.

Adult Singaporeans and permanent residents who have never had chicken pox can also get the vaccine at subsidised rates.

Q: How is shingles treated?

A: Dr Kurup said: “There is no cure for shingles. It simply has to run its course.

“Treatment focuses on pain relief. Painkillers may help relieve some of the pain. Other treatments may include creams or lotions to help relieve itching, cool compresses, steroids and, in some cases, anti-depressants and anti-convulsants.”

Anti-depressants and anti-convulsants are used to treat the nerve pain which can be so severe that normal painkillers are not strong enough, said Dr Kurup.

Antivirals, if taken within the first five days, may help to reduce some of the symptoms, such as skin sensitivity, itchiness and pain. The rash appears one to five days after the symptoms begin and looks like small red spots that later turn into blisters.

Prof Lim said antiviral medications have some effect but do not entirely prevent the post-herpes pain.

Q: Can I protect myself against shingles?

A: Dr Kurup said vaccination is the only way to protect against shingles.

Two vaccines are licensed for use here, but most clinics offer only the newer and better vaccine, Shingrix, which is more effective at preventing shingles than the older Zostavax. Shingrix confers more than 90 per cent protection, while Zostavax provides 50 to 60 per cent protection.

Prof Lim said Zostavax is a live vaccine so it cannot be given to people who are immunocompromised, although they need protection the most. They can get vaccinated with Shingrix, which is not a live vaccine and is more effective in protecting people aged 70 and older.

The US stopped the sale of Zostavax in 2020, and recommends those who had taken it to get vaccinated with Shingrix. Prof Lim said there is currently no recommendation for a booster shot to Shingrix, which is believed to confer long-term protection.

Q: How much does Shingrix cost and is there any subsidy?

A: Shingrix is given in two doses three months apart. The Travellers’ Health and Vaccination Clinic at TTSH charges $68.70 for the doctor’s consultation and $440 for each jab, so the total cost is $948.70.

There is currently no subsidy for the vaccine, which is not on the National Adult Immunisation Schedule (Nais). MediSave also cannot be used to pay for it.

However, the Ministry of Health (MOH) said it “is assessing the vaccine’s clinical- and cost-effectiveness at the population level”.

An MOH spokesman said that both the adult and childhood immunisation schedules “aim to prevent diseases with significant public health burden, by encouraging high vaccination take-up rates at the population level”.

“When reviewing vaccines to be included on the national schedules, the MOH consults the Expert Committee on Immunisation and takes into account criteria such as the disease burden in Singapore, clinical- and cost-effectiveness, and safety of the vaccine.”