Zostavax for Herpes Zoster (Shingles)
Tuesday, October 31, 2006
Paul Auerbach, M.D.
Zostavax is a new vaccine to reduce the risk for herpes zoster (HZ), commonly known as “shingles,” in elder adults. It is given as a single subcutaneous injection.Having encountered shingles in emergency department patients regularly over the years, and in a few unfortunate victims during adventure travel, I can state affirmatively that shingles can be quite debilitating. We are keeping our fingers crossed that this new vaccine will be as effective in the general population as it was demonstrated to be in a study population.
HZ is caused when varicella-zoster virus (VZV), which causes chickenpox, is reactivated from a latent or dormant (inactive) state. After an infection with VZV, a person can retain the virus, quite commonly in nerve tissue. While most cases of reactivation can not be linked definitively to a specific cause, some cases of viral reactivation are felt to be related to physiological stresses, such as extreme fatigue, suppression of the immune system, concurrent cancer, or intense exposure to environmental extremes (sunlight or heat), or significant emotional stress. Shingles is a situation wherein the virus becomes active in the distribution of one or more nerve roots, which are branches off the spinal cord.
In a typical episode of shingles, the victim (most commonly a person older than 60 years of age – but this is an affliction certainly seen in younger individuals as well) notes symptoms prior to eruption of the rash. These include a sensation of tingling or burning in the skin that will soon become reddened and blistered. Sometimes the tingling and burning can become sharply and intensely painful prior to appearance of the rash. When the skin is examined at this stage, it may appear normal.
Within a few days of the abnormal sensations, the skin reddens and blisters, with clusters of fluid-filled skin bubbles corresponding to the distribution of the particular involved nerve(s). During this stage, pain may be very severe. If the face, mouth, eyes, or genitals are involved, a person may have difficulty with eating, vision, or urinating.
After a case of HZ, the victim may suffer the complication of postherpetic neuralgia (PHN), which may cause debilitating pain for months. PHN is often defined as severe pain associated with HZ that persists for 90 days after the initial onset of pain.
Treatment for acute HZ includes prompt administration of an antiviral drug, such as famciclovir or acyclovir. However, this treatment is not curative, but rather, shortens the duration of the rash and pain. Furthermore, the antiviral agents do not seem to prevent the occurrence of PHN.
Zostavax is a vaccine from the pharmaceutical company Merck composed of live attenuated VZV. In one large study, vaccine administration in an elder population decreased the incidence of shingles by 51% and also diminished the duration and severity of pain and discomfort in recipients of the vaccine who developed shingles, as compared to non-immunized individuals. Immunized individuals also showed a lower incidence of postherpetic neuralgia, although this effect may largely be attributed to the decreased incidence of HZ. The beneficial effects declined as the age of the recipients rose, with the youngest age being 60 years, and the oldest begin greater than 80 years. This observation may have to do with declining immune response (to the vaccine) with increasing age.
As physicians and patients accumulate more experience with the vaccine, it may become an important immunization for elders as they prepare to embark on wilderness adventures, where an episode of HZ might at best be inconvenient, and at worse, become a medical cause for discontinuation of the trip.
Tags: Zostavax, herpes zoster, shingles, wilderness medicine, outdoor medicine, healthline
photo by Paul Auerbach
17 Comments:
At Tue Oct 31, 12:26:00 PM 2006,
Jolie Bookspan, M.Ed, PhD said…
Thanks Doc, always helpful info.
Would you recomment the vaccine to someone in their 40s (or 50s) who has had shingles to prevent recurrance, given no complicating health factors (or even with)?
At Sun Nov 05, 08:50:00 AM 2006,
Paul Auerbach, M.D. said…
According to the FDA, Zostavax has not been studied among people who have had shingles. Therefore, the effectiveness in preventing repeated episodes is not known. However, most people who are stricken with shingles never suffer another episode (although it is possible). Therefore, the vaccine is not currently recommended for someone who has previously suffered shingles.
At Sun Nov 05, 06:51:00 PM 2006,
Anonymous said…
Has anyone addressed the problem that insurance companies are not covering the Shingles vaccine? The cost is $200. We carry three insurance plans, Medicare & two Blue Cross policies & none cover the cost.
At Mon Nov 06, 02:43:00 PM 2006,
Anonymous said…
If a loved one is currently having a shingles outbreak, should their spouse (both over 60 yrs. old) take the vaccine right now or wait and why?
At Tue Nov 07, 08:32:00 AM 2006,
Paul Auerbach, M.D. said…
As your particular question is posed, there is no reason to wait to take the vaccine.
At Wed Nov 08, 03:17:00 PM 2006,
Anonymous said…
I talked to Medicare today (11-08-06). they will cover the shot.
At Thu Nov 09, 04:59:00 PM 2006,
Anonymous said…
I am a 68 year old grandma... I had the shot this afternoon... PacMed had just received the vaccine at noon today. Didn't get any ideas of possible side effects, etc... so I said if I have any I will let them know.
At Fri Nov 10, 07:37:00 PM 2006,
sismolnar said…
Have previously had shingles. Had the vaccination yesterday. Side effects seem so far to be a raised rash below the shot site, and now 30 hrs. later, the site itches pretty strongly. Is this normal? I sure hope it doesn't give me shingles again!
68 year old grandma
At Sat Oct 13, 11:20:00 AM 2007,
Anonymous said…
I spoke with 2 doctors. 1 said I should have the vaccine, the other said, since I have had singles it would not do me any good. Now I am not sure what to do. Can you help?
At Tue Dec 18, 03:11:00 PM 2007,
Anonymous said…
Can you get from someone if you had the vaccine 33 years ago.
At Tue Jan 22, 01:16:00 PM 2008,
diane said…
I received the vaccine 5 weeks ago and on the third day broke out in blisters all over my body. They are very painful along with a severe headache. I went to a dermatologist and she said she has never seen blisters like this and that she has another patient that received the vaccine and they are having terrible reactions. I called Merck to see if anyone could tell me how to counteract this reaction and no one would talk to me. Do not get the vaccine. If Merck will not help do not put yourself through this possible pain.
At Mon Jan 28, 02:38:00 PM 2008,
Terri said…
Dr Auerbach:
I was diagnosed with CIDP which has now been downgraded to periperhal neuropathy. Can I safely get a shingles vaccine? I had chicken pox as a child and am 73 years old.
Thanks
At Thu Feb 07, 09:03:00 AM 2008,
mrsmac said…
My husband (63) currently has shingles. I have had the chickenpox vaccine. Am I at risk for getting this from him?
At Tue Mar 04, 12:42:00 AM 2008,
Anonymous said…
What is the success rate of this drug? What are some of the risks or side effects if any? Where can I recieve the vaccination? Is there any particular individuals that shouldn't get the vaccination? Do insurance companies cover getting the vaccine and if not how much would it cost? Do you think that this vaccine will end up being like the chicken pox vaccine, available to everyone? Do you suggest for people under sixty to get vaccinated?
At Wed Apr 16, 07:10:00 AM 2008,
Anonymous said…
My mother had singles on her cornea and in her head. (They eventually destroyed her entire eye.)She suffered terribly and had pain years later. The doctor, who treated her, recommended the vacine. He said he was going to get it when he reached 60. He highly recommended it to me.
At Thu May 08, 08:06:00 AM 2008,
Anonymous said…
After receiving the vaccine about a week ago I read that anyone taking a steroid drug should not take it. I have been on Advair for several years and wonder what the adverse reactions may be.
At Thu Aug 14, 11:27:00 AM 2008,
Anonymous said…
Can you get shingles all over your body? It looks like shingles and acts like shingles, but my doc wasn't sure! The first time I had them I was 12 (I'm 56 now) and it was located in one small area. Now I have them under my rt. arm, back of my rt, thigh, my lft. knee and various other smaller areas all over my body!
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