The \u201clightning strike\u201d pain was like nothing Francine Jones had experienced before. \u201cThat is the only way I can describe it,\u201d she says, of the stabbing in her torso that would occur every 10 minutes or so. \u201cIt was a really sharp, intense pain, as if someone was giving me an electric shock \u2026 it took my breath away.\u201d<\/p>\n
It had started in May with a strange pricking sensation under her bra. Then 10 large blisters, plus a host of smaller ones, formed in a band from her stomach to her back. They burned, \u201clike someone was putting an iron on me. I don\u2019t think I wore underwear for five or six weeks.\u201d Showering, or even a cold flannel, would make her skin burn. Then came \u201cthe itch\u201d, which lasted for five weeks and was so intense that she was lucky if she slept for four hours a night. \u201cIt was like something was crawling all over me all the time.\u201d I can hear her wincing.<\/p>\n
Jones is describing the stages of shingles she experienced. \u201cStages\u201d is her terminology; there is no set pattern. It is her way of describing how the illness progressed. One night, she even feared she was having a heart attack. \u201cI felt like I had a constant stitch and it intensified to where I was unable to walk,\u201d she recalls. \u201cI tried to take a deep breath and then the pain got worse. I was crying my eyes out.\u201d<\/p>\n
The healthcare assistant from Hereford is 39, not an age at which you might expect someone to get shingles. Yet she is not as much of a rarity as you might expect. Her story reflects a concerning trend: a 2019 US research paper reported that the sharpest rise in shingles cases was among those aged 30 to 49. Between 1998 and 2017, cases of shingles in this cohort more than doubled, overtaking the trajectory of older groups, although the latter experienced more cases overall. (Cases across all groups have been rising steadily in the US for decades, a trend for which experts do not appear to have a clear explanation, although they speculate that increased stress and depression, contributing to weakened immunity \u2013 a key cause of shingles \u2013 may play a role.)<\/p>\n
After being diagnosed by a pharmacist, Jones was prescribed antiviral medication for seven days, then the nerve pain medication Gabapentin, which she is still taking. She has been off work for two months and still experiences sporadic aching in her side, as if she has twisted badly.<\/p>\n
Francine Jones had a band of painful blisters from her stomach to her back. Photograph: Handout<\/p>\n
\u201cI always thought it was old people who got shingles,\u201d she says. In fact, a US study published in the journal Clinical Infectious Diseases<\/a> this year found that those aged 30 to 39 with certain conditions, including asthma, diabetes, depression and stress, had a higher risk of shingles than those aged 50 to 59 who were immunocompetent. Experts say the uptake of the shingles vaccine in the over-50s in the US is still too low to offer an explanation for this.<\/p>\n Shingles, also known as herpes zoster, is a reactivation of the varicella zoster (chickenpox) virus, which lies dormant in the sensory dorsal root ganglia \u2013 a cluster of neuron cell bodies just outside the spinal cord \u2013 after the contraction, often in childhood, of chickenpox. Reactivation can be triggered when immunity is impaired and T-cells in our blood can no longer keep it in check. The first symptom is usually pain or tingling in one area of the skin, sometimes accompanied by headaches and generally feeling unwell. This is typically followed by blisters. Pain is caused by inflamed nerves \u2013 one complication can be postherpetic neuralgia (persistent pain for more than 90 days), which occurs in around 20% of patients<\/a>.<\/p>\n An illustration of the varicella zoster virus. Photograph: Roger Harris\/Science Photo Library\/Getty Images\/Science Photo Library RF<\/p>\n According to the NHS, around a quarter of us<\/a> will experience shingles in our lifetime and the incidence increases with age, which is why the shingles vaccination is offered to those over 65 in the UK and those over 50 in the US. Cases in the UK are above the five year average, according to the Royal College of GPs Research and Surveillance Centre. It believes this may, in part, reflect additional diagnoses through the Pharmacy First scheme, which allows pharmacists as well as GPs to diagnose shingles and prescribe treatment.<\/p>\n \u201cI\u2019ve had shingles eight times in the last two years. I\u2019m 38 years old,\u201d wrote one woman, in a Facebook support group for those with shingles. \u201cI had shingles in April for the first time at 36,\u201d said another. Others have similar stories: \u201cI got it last year at 32\u201d; \u201cI had it at 41 this time last year but I\u2019ve only just finished recovering\u201d; \u201cI\u2019m 44, got shingles last year and it was horrific, the pain!\u201d The majority of voices are female. Across most age groups, women have a 56% higher chance of developing<\/a> shingles, thought to be because their immune systems work differently from men\u2019s (women are more prone to autoimmune conditions, for example).<\/p>\n In the US, one hypothesis for the rise in shingles is that the introduction in 1995 of the chickenpox vaccine for children, which eventually lowered rates of infection in young age groups, means adults who have not been vaccinated are missing out on exposure to chickenpox, and therefore the boosts to their own resilience to shingles.<\/p>\n Indeed, the 2019 study expected to find this, especially when it came to explaining the rise in shingles in the millennial cohort, who are too old to have had the chickenpox vaccine and too young for the shingles vaccine.<\/p>\n