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Health & Medicine for Senior Citizens

Herpes Zoster Vaccine Associated With Lower Risk of Shingles in Most Older Adults

Confirms other studies showing more than half of seniors will be protected by shot but they are still not getting it (not covered by Medicare) - link to video in story

Photograph of a male doctor talking with a senior female patientJan. 11, 2011 – A new study confirmed what previous research has shown about the effectiveness of the shingles vaccination for senior citizens – it protects slightly more than half who get the shot from the painful rash that can be disabling. This study looked at a large group of older adults and found the vaccination reduced the risk of shingles, regardless of age, race or the presence of chronic diseases.

It did not, however, shed new light on why so many senior citizens are not getting the preventive shot. A significant reason that is not often discussed, however, is that Medicare does not pay for the treatment. The Centers for Disease Control and Prevention reports the vaccination is covered by Medicare Part D prescription drug plans, although, the senior will have to cover the copayment.

The typical price for a vaccination is between $200 and $250.

 

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Family History of Shingles May Be Motivator to Get Vaccination

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Shingles, also known as herpes zoster, is caused by reactivation of the virus that causes chickenpox. Once chickenpox infection has run its course, the virus is not eliminated; rather, it retreats to clusters of sensory nerve cells usually located near the spinal cord, where the virus persists in a dormant state.

As immunity weakens with advancing age, the virus can reactivate, multiply in and damage sensory nerve cells to cause pain. It then migrates to the skin, causing the blistering rash of shingles.

Click to JAMA Video

Generally, shingles first manifests as pain, itching or tingling in an area of skin on one side of the body or face. Then a painful blistering rash develops in that same area of skin; the rash can take two to four weeks to heal.

Anyone who has had chickenpox - which includes most adults in the United States - could develop shingles, though not all will. The two major risk factors are increasing age and declining immunity. Half of all people who live to age 85 will get the disease.

"The pain of herpes zoster is often disabling and can last for months or even years, a complication termed postherpetic neuralgia. Approximately one million episodes of herpes zoster occur in the United States annually, but aside from age and immunosuppression, risk factors for this condition are not known," the researchers write in the January 12 issue of the Journal of the American Medical Association (JAMA).

Zostavax is the only US licensed vaccine that reduces the risk of reactivation of the varicella zoster virus, the same one that causes chicken pox, and remains dormant in the body after recovering from this infection.

Earlier data provided evidence that herpes zoster vaccine works in a select study population under idealized circumstances, but these researchers decided the vaccine needed to be evaluated in field conditions to show whether benefits of the vaccine can be generalized to conditions of clinical practice.

The researchers note that this is particularly important for the herpes zoster vaccine, given the medical and physiological diversity in the elderly population for whom the vaccine is recommended by the Centers for Disease Control and Prevention.

Hung Fu Tseng, Ph.D., M.P.H., of Southern California Kaiser Permanente, Pasadena, Calif., and colleagues evaluated the risk of herpes zoster after receipt of herpes zoster vaccine among individuals in general practice settings.

The study included community-dwelling adults, age 60 years or older, who were members of a managed care organization. There were 75,761 members in the vaccinated cohort, who were age matched (1:3) to 227,283 unvaccinated members.

Compared with the unvaccinated cohort, individuals in the vaccinated cohort were more likely to be white, women, and to have had more outpatient visits, and a lower prevalence of chronic diseases.

There were 5,434 herpes zoster cases identified in the study (6.4 cases per 1,000 persons per year among vaccinated individuals and 13.0 cases per 1,000 persons per year among unvaccinated individuals).

About Shingles

Shingles is a disease caused by the varicella-zoster virus - the same virus that causes chickenpox. After you have chickenpox, the virus stays in your body. It may not cause problems for many years. As you get older, the virus may reappear as shingles. Unlike chickenpox, you can't catch shingles from someone who has it.

Early signs of shingles include burning or shooting pain and tingling or itching, usually on one side of the body or face. The pain can be mild to severe. Blisters then form and last from one to 14 days. If shingles appears on your face, it may affect your vision or hearing. The pain of shingles may last for weeks, months or even years after the blisters have healed.

There is no cure for shingles. Early treatment with medicines that fight the virus may help. These medicines may also help prevent lingering pain. A vaccine may prevent shingles or lessen its effects. The vaccine is for people 60 or over.

NIH: National Institute of Allergy and Infectious Diseases

In the fully adjusted analysis, vaccination was associated with reduced risk of herpes zoster. The reduction in risk did not vary by age at vaccination, sex, race, or with presence of chronic diseases.

Herpes zoster vaccine recipients had reduced risks of ophthalmic (near the eye) herpes zoster and hospitalizations coded as herpes zoster.

Overall, the vaccine was associated with a 55 percent reduction in incidence of herpes zoster.

"Herpes zoster vaccine (Zostavax) was licensed recently, which means the durability of its protection needs to be assessed in future studies. Meanwhile, however, this vaccine has the potential to annually prevent tens of thousands of cases of herpes zoster and postherpetic neuralgia nationally.

“To date, herpes zoster vaccine uptake has been poor due to weaknesses in the adult vaccine infrastructure and also due to serious barriers to the vaccine among clinicians and patients. Solutions to these challenges need to be found so that individuals seeking to receive herpes zoster vaccine will be able to reduce their risk of experiencing this serious condition," the authors conclude.

The Food and Drug Administrations says other studies have shown the vaccination to reduce the frequency of pain associated with shingles for older people.

"In people who were 70 years of age and older, and still developed shingles, even though they had been vaccinated, Zostavax reduced the frequency of PHN, the pain associated with the illness. Overall, the benefit of Zostavax in preventing PHN is due to the effect of the vaccine on reducing the risk of developing herpes zoster (shingles). Zostavax will not work to treat PHN," according to the FDA website.

>> Questions and Answers at the FDA on Zostavax (Herpes Zoster Vaccine)

>> Questions and Answers at the CDS on Shingles Vaccination

 

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