Growing up in San Francisco in the 1930s and 1940s, Dianne Goldman endured outbreaks of polio, diphtheria, whooping cough, measles, mumps, and chickenpox. With vaccines for many childhood illnesses still at least a decade away, plagues like these claimed more than a quarter of the world’s youth before reaching puberty.

Now one of those ailments has caught up with Dianne, who, at age 89, is better known as Senator Feinstein. Shingles caused by a virus left behind after a case of chicken pox threatens to end the storied political career of California’s longest-serving senator.

In early March, Feinstein announced she had been hospitalized for about two weeks for shingles after suffering the painful, blistering rash that heralded the reawakening of the long-dormant varicella zoster virus.

Feinstein’s office has not provided further details about the course of her illness or the extent of her disability. The senator is known to have had a pacemaker implanted in 2017. There are widespread rumors that a decline in her cognitive health has jeopardized her ability to fulfill her Senate duties, but neither Feinstein nor her staff has recently allayed those concerns.

At least for now, shingles seems to explain her absence from the Senate.

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A case of shingles can leave a younger patient with two weeks of burning pain before it clears up on its own. But in older patients, it is much more likely to last longer and involve chronic nerve pain.

This is the only disease we vaccinate against, despite the fact that it doesn’t actually kill people, said Mayo Clinic geriatrician Dr. Amit A Shah. The reason is that it can be terribly painful, sometimes for weeks or months. For some, it never goes away and can be turned off.

For anyone who had a bout of chickenpox (or varicella) as a child and that means virtually every American now over the age of about 30, the threat of shingles begins to escalate around the middle of the century. Throughout life, an unvaccinated person who has ever had chickenpox has about a 1 in 3 chance of developing the painful, blistering disease.

While the rash usually spreads over one side of the scalp, neck, back, or buttocks, the reactivated varicella zoster virus is capable of even worse mischief.

In as many as 20% of cases, the virus can travel up the optic nerve and enter the eye, causing severe eye pain, glaucoma, or vision loss. In rarer cases, it can enter the brain and cause inflammation and swelling that can lead to stroke-like symptoms. In people with extremely compromised immune systems, the virus can cause a rash on both sides of the body, a sign that it can invade and attack organs.

Any of these worst-case scenarios would land a shingles patient in the hospital. And each of those is likely to leave a patient worse off for some time.

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It’s especially devastating for his oldest patients, Shah said. You have to give patients six months or more to figure out where they end up. As many as half of those who get shingles at age 85 or older will end up with damaged nerves and chronic nerve pain, studies show.

To treat that pain, doctors prescribe a wide variety of medications that can cause sedation and dizziness. For seniors in particular, some of those can increase the risk of falls and other accidents that can even spell the doom of seniors who are still largely healthy, said Dr. David H. Canaday, an infectious disease physician at Case Western Reserve

University Medical Faculty Medical Faculty.

We see it even in patients who are not very old or frail, Canaday said. If something bothers you that makes you move less, become less active for a while, it can start a huge downward spiral.

A case of shingles also increases the risk of stroke and heart attacks. In a study published in Dec

2022

, researchers at Brigham and Women’s Hospital in Boston found that people who suffered from shingles were 30% more likely than those who did not have a cardiovascular event that required hospital treatment. The increased risk persisted for at least 12 years after the shingles resolved.

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For some patients who recognize shingles quickly, a rapid course of antivirals can shorten the course of the infection and reduce its severity. But prevention is a better bet.

In 2017, the U.S. Food and Drug Administration approved a two-dose vaccine that can prevent shingles in adults age 50 and older for at least 10 years. Large clinical trials showed that Shingrix reduced the risk of shingles by 97% in people aged 50 and over, and by 90% in people aged 70 and over. It replaces an earlier but less effective vaccine with a different design, Zostavax, which has been available since 2006.

While there is some evidence for a link between shingles and subsequent dementia, that relationship is still murky.

Dr Sharon E. Curhan, who led the research team linking shingles to cardiovascular events, sifted through years of data collected by the Nurses Health Study and several large studies that built on it. Her team investigated whether cognitive decline is more common after a case of shingles. The findings are expected to be published soon.