The Shingles Shot
"Shingles" is one of those marvelously quaint old medical terms that could have gone the way of "dropsy" and "rheumatism" but still happens to be in use.
Cool word. Bad disease.
Shingles refers to the reactivation of chicken pox virus (herpes zoster) along a nerve, causing pain and a blistery rash, usually on the flank, face, or buttocks. Most often the pain and the rash disappear in a few days but in about 10% of people with shingles, the pain along the nerve persists indefinitely. This complication, called post-herpetic neuralgia (PHN) can be difficult to control and very disabling--even life ruining. If shingles appears near the eye, it can threaten vision.
In 2006, the FDA approved Zostavax, a vaccine containing live chicken pox virus. It appears to prevent shingles in up to 70% of people over 50 who receive it--though when given to older people, effectiveness lessens. The vaccine was originally recommended for everyone over 60, but it's now advised that everyone over 50 receive it. Shingles can occur at any age but the older you are, the more likely you are to get it.
For a while, supplies of the vaccine, manufactured by Merck, were limited, but it's now readily available. Zostavax is covered by Medicare Part D and costs about $160 when not covered by insurance.
Detailed information about Zostavax is available here. Some key points are:
People who are allergic to neomycin, take corticosteroids (e.g. Prednisone), or are immuncompromised or pregnant should not receive Zostavax.
People considering Zostavax should tell their doctor if they're unsure if they've ever had chicken pox, or if they may have close contact with a pregnant woman.
Shingles usually doesn't recur, but it can--so Zostavax is still recommended in people who have already had shingles.
Vaccines have always inspired controversy, and Zostavax is no exception. I've had many patients express reluctance to get a vaccine that contains live virus, hasn't been around long, and protects against a disease with a funny, old-fashioned name and with which they may not be very familiar.
The one group I've noticed needs little encouragement to get Zostavax are people who've known someone who's had shingles, especially PHN--they'll do anything to avoid it.
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About the author
Suzanne Koven, M.D. practices internal medicine at Massachusetts General Hospital in Boston. She writes a monthly column for the Globe's G Health section and her essays have appeared in the More »Recent blog posts
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