Despite being vaccinated against shingles, Sen. Dianne Feinstein (D-CA) developed encephalitis, a rare complication from her infection that can cause long-term nerve damage and cognitive impairments.
Although Feinstein stated earlier this month that she is “still experiencing some side effects from the shingles virus” that hospitalized her in February, her spokesman, Adam Russell, told the Washington Post on Friday that she recovered from her case of encephalitis, or inflammation of the brain, that was caused by the outbreak.
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A case of encephalitis arising from a shingles outbreak, medically known as varicella zoster virus, or VZV, encephalitis, is “extremely rare,” according to Dr. Avindra Nath, clinical director of the National Institute of Neurological Disorders and Stroke with the National Institutes of Health.
Nath, a specialist in disorders of the nervous system, told the Washington Examiner that the most common cases of VZV encephalitis are in severely immunocompromised populations, such as patients with HIV or certain cancers.
Age is also a risk factor for developing more severe shingles complications.
“As you get older, nothing works. Your immune system also deteriorates, so you become more vulnerable to all kinds of infections,” Nath said.
The NINDS identifies a range of physical symptoms of encephalitis, including speech and hearing impairment, double vision, partial arm and leg paralysis, and seizures. Cognitive complications of encephalitis range from personality changes and impaired judgment to hallucinations and memory loss.
The Encephalitis Society, a support and advocacy group for those affected by the disease, notes that the disease can cause significant long-term behavioral and emotional changes in the patient even after the infection clears and the inflammation decreases, including mood swings, aggression, impulsiveness, and poor emotional regulation.
Nath explained that there are different types of encephalitis and that the inflammation can affect particular parts of the brain in different ways. “It doesn’t necessarily have to be throughout the brain,” but general encephalitis is “very devastating and really not compatible with life.”
Feinstein also developed Ramsay Hunt syndrome from her VZV infection. The Mayo Clinic identifies inner ear pain, vertigo, and facial paralysis as primary symptoms of the syndrome, in addition to postherpetic neuralgia, or inflammation of nerve fibers. Possttherpetic neuralgia can cause intense pain that “may last long after other signs and symptoms of Ramsay Hunt Syndrome have faded,” according to the Mayo Clinic.
Feinstein’s May 11 statement indicated that she had been vaccinated against shingles, but it is unclear which of the two shingles vaccinations Feinstein received and when she received the vaccine.
Zostravax, which was approved in 2006 and is now an outdated vaccine, has an overall efficacy rate of 50% for preventing shingles in people aged 60 and older, according to the Food and Drug Administration. Its efficacy for those over the age of 80 is only 18%.
The newer vaccine, Shingrix, is 91% effective in preventing a shingles infection and 89% effective in preventing the development of postherpetic neuralgia complications in patients 70 years and older, according to the Centers for Disease Control and Prevention, but protection wanes overtime.
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Nath said the “good news” is the availability of effective antiviral drugs that, if administered early, “could prevent a lot of the complications of the virus.”
Although Nath could not speculate about Feinstein’s condition, he stated that “long-term consequences would really depend on how much brain destruction has taken place. If you lose a substantial amount of the brain, then recovery is harder. … The older you are, the recovery is less, but some recovery can occur. It just depends upon how much area of the brain it affected and how early they were actually able to treat it.”
