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CDC recommends shingles vaccine for older adults

Posted by Elizabeth Cooney May 15, 2008 05:53 PM

It's official: Adults 60 and over should get a vaccine against the virus that causes shingles, government health experts said today.

The US Centers for Disease Control and Prevention recommends a single dose of Zostavax even for people who have already had a case of shingles to prevent the painful condition and its potentially long-lasting after-effects. The vaccine was approved by the Food and Drug Administration in 2006 and CDC issued a provisional recommendation then.

Dr. Martin S. Hirsch, a member of the infectious disease unit at Massachusetts General Hospital, has had shingles himself and has seen its severe complications in patients.

"I’m over 60 and I took the vaccine myself," said in an interview. "I recommend it for all people over the age of 60 unless they have a condition where it would not be safe."

Shingles comes from the same virus that causes chicken pox. Anyone who has had chicken pox -- 95 percent of the US adult population -- is vulnerable to an outbreak of shingles because the virus can lie dormant for decades near nerve roots along the spinal cord. Stress, a weakened immune system, and age can allow the virus to be reactivated. Half of people who have reached the age of 85 have already had shingles or will have a case.

Shingles can cause a blistering rash and headache, and rarely hearing loss, blindness, encephalitis, pneumonia, or death. Severe pain can linger for months or years as a condition called post-herpetic neuralgia that is more common among older people. After age 50, people are far more likely to suffer this complication.

The vaccine was tested among people 60 and older in a large randomized clinical trial that showed it blocked the disease in half the people and cut the incidence of post-herpetic neuralgia by two-thirds in those who still got shingles after being vaccinated.

"The vaccine itself is pretty safe. The only problem with it is that it’s expensive," Dr. Hirsch said. But "the payments for a case of shingles or post-herpetic neuralgia are far greater than one would have to pay for this vaccine."

The vaccine, made by Merck, can cost more than $150. People over 65 who have the Medicare Part D prescription plan will have the cost covered.

The vaccine is already covered for people 60 and older by all members of the Massachusetts Association of Health Plans, president Dr. Marylou Buyse said. Member plans include Aetna, US Healthcare Inc., Fallon Community Health Plan, Harvard Pilgrim Health Care, Harvard University Group Health Program, Health New England, Neighborhood Health Plan, Network Health, and Tufts Health Plan.

37 comments so far...
  1. This wouldn't be happening if kids were still getting chicken pox!! So, what's easier--to have lifelong immunity to chicken pox and shingles through constant exposure, or to have to gets shots every five years or so for life?

    Moreover, the chicken pox shot isn't really that effective (outbreaks happen due to vaccine failure all the time). This would result in girls who might be immune as children, but who might get to their childbearing years without immunity with horrible consequences for their babies in utero.

    It's good that Merck has found another way to make money considering that it's been under attack lately for troubles at its vaccine manufacturing plants and with some of its new drugs. http://www.msnbc.msn.com/id/24454079/ Remember this when you're buying the super-expensive shingles vaccine!

    Posted by Beth May 15, 08 07:55 PM
  1. Beth, have you ever had shingles? I've had chicken pox AND shingles and shingles are no picnic (understatement of the year). I'm only 41 but if getting the vaccine would prevent me from getting shingles again I'd be the first in line. It was horrible enough as healthy 35 year old - it must be excrutiating for an elderly person. Google Shingles and David Letterman and see what he had to say about it - he couldn't do his show for six weeks. Unfortunately I don't think I can get the vaccine because I'm too young.

    Go Merck!

    Posted by Cordelia Potter May 15, 08 08:44 PM
  1. In response to Beth...,

    I think you misread the article. Having had chicken pox makes you vulnerable to shingles, not immune to them.

    Posted by Victor May 15, 08 08:45 PM
  1. What if you never had chicken pox. do you still need the shot????

    Posted by Charlotte Lawton May 15, 08 08:56 PM
  1. If you've never had chicken pox, then you couldn't get shingles. Older folks who have had chicken pox can get shingles because some of the virus continues to live after the pox has gone.

    Posted by efw May 15, 08 09:00 PM
  1. I prob should get the shot.

    Posted by Beth May 15, 08 09:00 PM
  1. Read a bit more carefully before you spout off like that, Beth:

    "Anyone who has had chicken pox -- 95 percent of the US adult population -- is vulnerable to an outbreak of shingles "

    Having chicken pox in the past is the reason you get shingles, it does not make you immune. I know a co-worker in her 50's who got shingles (she had had chicken pox as a youth) and she said it was one of the most painful few months she ever endured.

    Posted by Andy May 15, 08 09:13 PM
  1. Hey Beth, maybe you should do your homework before putting comment out there and looking uneducated. Shingles happens to people who already had chicken pox. Therefore, someone who has had chicken pox can then get shingles later on in life. Maybe next time you will do a little more research.

    Posted by wesley May 15, 08 09:29 PM
  1. Beth needs to stop the anti-pharma rant. Note the feds are recommending this for those over 60. There are not many pharma products that they recommend and this is warrented. There was plenty of shingles and suffering when 'kids were getting chicken pox', this is well described in the literature. It is true that the vaccine only reduces your chances by about 50% in the years studied- but this is really a booster for something you are already infected with- not primary prevention. Good enough. Well done Merck!

    Posted by Brian May 15, 08 09:31 PM
  1. Beth, have you ever had shingles, you seem to know so much about it? Shingles can only occur in people that have HAD chicken pox. There is no lifelong immunity to shingles other than not getting chicken pox. I have had the shingles, and it was one of the worst experiences of my life. Give me the shot every year if it will prevent me from getting this painful disease again. I still have problems with my right leg, and I am only 51!

    Posted by Stephanie May 15, 08 09:50 PM
  1. Uhh... no. While I agree that natural immunity to chicken pox is preferable to the vaccine, you are incorrect that "this wouldn't be happening if kids were still getting chicken pox!!" Did you not read the part about people who've HAD chicken pox being susceptible to shingles? Also, the vaccine has only been around for about 25 years; why is it that people over 60 are most likely to get shingles? They never had the VZ (chicken pox) vaccine as children...

    Posted by Kathleen May 15, 08 09:53 PM
  1. Beth, you can only get shingles if you've actually had chicken pox, so I don't think the chicken pox vaccine has anything to do with shingles. Plus, that vaccine hasn't been around very long, so most people who've had the chicken pox vaccine aren't even in their 20's yet.

    Posted by Mike May 15, 08 10:02 PM
  1. "Shingles comes from the same virus that causes chicken pox. Anyone who has had chicken pox -- 95 percent of the US adult population -- is vulnerable to an outbreak of shingles because the virus can lie dormant for decades near nerve roots along the spinal cord."

    Posted by Peter May 15, 08 10:03 PM
  1. This is the source for what I am saying below:
    http://www.medicalnewstoday.com/articles/44187.php

    This is the quote of importance: "The catalog price of ZOSTAVAX is $145.35 purchased as a 10-pack of single-dose vials of lyophilized vaccine with sterile diluent and $152.50 purchased as a single-dose vial of vaccine with sterile diluent. " (lyophilized means "freeze-dried)

    I am not a medical person but it sounds to me that if you had ten people to receive the vaccine it would cost about $15.00 each which seems doable. I am presuming that that is what it means when it says "as a 10-pack". The problem is that we are not having Shingles vaccine days the way we have "Flu-shot" days. Doctors are not carrying the vaccine because of the specific refrigeration requirements and the same is true of pharmacies. If the vaccine is not being purchased, it does not take a rocket scientist to figure out that Merck-Medco will cease to produce it. I have raised this issue with my Congress person, Mr. Tierney, but so far have not seen any concrete measure taken to address this very real problem. The vaccine might as well be on the moon if we cannot get it.

    Posted by Mary Sweeney May 15, 08 10:45 PM
  1. No, Beth. It is getting chicken pox that causes shingles. If you never get chicken pox, you don't get shingles because you don't have the virus dormant in your system.

    Posted by NancyG May 15, 08 10:58 PM
  1. Beth, try not to comment unless you know what you're talking about. "Constant exposure" to chicken pox doesn't confer lifelong immunity from shingles - it's the same virus, whether you get it from the vaccine (in weakened form) or by getting itchy red bumps all over. I should know: I've had chicken pox three times, twice before the age of 18. That still didn't prevent me from getting a nasty case of shingles!

    Posted by Kat May 15, 08 11:16 PM
  1. This is in reply to Beth:

    I am puzzled by your saying that "This wouldn't be happening if kids were still getting chicken pox!!" My understanding is that you only get shingles if you have had chicken pox. The virus remains in your system for life and can reactivate as shingles in later years and have very serious effects. You can lose your sight or hearing or suffer severe and debilitating pain for an extended period of time, depending upon the nerve path affected. If kids were still getting chicken pox, they would be at risk for shingles. I am in my 60's. I had chicken pox; therefore I am at risk for shingles.

    Posted by Mary Sweeney May 15, 08 11:19 PM
  1. I am afraid you have it backwards. It is exposure to and then contracting chicken pox that makes it possible to get shingles. As the article states: "Shingles comes from the same virus that causes chicken pox. Anyone who has had chicken pox -- 95 percent of the US adult population -- is vulnerable to an outbreak of shingles because the virus can lie dormant for decades near nerve roots along the spinal cord."

    Posted by David May 16, 08 12:15 AM
  1. beth, can't you read? You get shingles (and I've had them) because you HAD the chicken pox. Having the chicken pox doesn't make you immure to shingles it makes you likely to get it eventually. So getting your kids chicken pox vaccinations protects against both the pox and shingles.
    You know I have my issues with Western medicine and its reliance on profit-driven drugs, but vaccines are one of the more holistic and effective parts of Western medicine.

    Posted by rwc May 16, 08 04:13 AM
  1. You've got it backwards. Only people who HAVE had chicken pox can get shingles.

    Posted by David May 16, 08 06:43 AM
  1. I'm not defending Beth (see my earlier post) but here is an anecdote. Our family doctor told me that he never used to see shingles in kids before the chicken pox vaccine became available (around 10 years ago in my area) and now he has seen many cases. I believe these are kids who did not have chicken pox but had the vaccine instead and then got shingles. As with chicken pox, it was much milder than what an older person would get but still painful.

    Does anyone know if the vaccine will prevent a reoccurrence of shingles?

    Posted by Cordelia Potter May 16, 08 07:56 AM
  1. rwc wrote "So getting your kids chicken pox vaccinations protects against both the pox and shingles. "

    This is not accurate. I have known children who have been vaccinated against chicken pox and developed shingles: aged 10. I have not researched to see if there are any scientific studies to determine if the prevalence is higher in vaccinated children vs. natural disease but I can tell you it does occur. The children are given a weakened virus but they do have the varicella (chicken pox) virus in their systems after vaccination.

    Posted by Mary C. May 16, 08 11:32 AM
  1. The vaccine will not necessarily prevent a reoccurrence of shingles. It may but it will lessen the excruciating nerve ending after effects. I have had shingles several times. As I am in my early fifties I have been told I have to wait to have the vaccine until I am 60. It is to do with immune response. My Doctor and I currently manage my shingles with Acyclovir.

    Posted by Mary Swenson May 16, 08 11:34 AM
  1. Let's stop harassing Beth. Enough already!

    Posted by Maria May 16, 08 12:28 PM
  1. I'm recovering from shingles - brought on by extreme stress - and it's not something I ever want to have again! Even though my derm says I may not have another shingles outbreak for 10 years or so, I say better safe than sorry.

    As soon as my primary doctor will order it, I'll get the vaccine in a few months. Had I known that it existed earlier, I could possibly have saved myself over a month of pain, discomfort and a LOT MORE STRESS!

    Posted by Susan Torrico May 16, 08 01:16 PM
  1. I had shingles a year and a half ago at the healthy age of 23! My pain only lasted about a month, because there is medicine that if taken in the first two to three days of the outbreak greatly reduces the outbreak and the long term effects. It was excruciatingly painful - I cannot imagine an elederly individual enduring it, let alone the lasting effects. I have strongly urged by parents (nearing 60) to get the vaccine and would strongly recommend it to everyone as soon as it is available to you. My understanding is that risk of getting shingles twice is low, but possible so I plan to get vaccinated ASAP - I never want to go through that amount of pain again especially what I am older, less healthly, and at risk of long term pain.

    Posted by Liz May 16, 08 01:34 PM
  1. I think that there's an anti-vaccine hysteria now and that's for good reason. Back in the 60's when I was a kid, we got several vaccines a year. Now, babies are getting over a dozen vaccines in their first six months and to be "fully vaccinated" a child would have something like 50 doses of vaccines by the time they are six years old.

    That's way too much and kids are being vaccinated for things they aren't likely to get unless they are illegal IV drug users (Hepatitis B). Then there's the whole vaccine-Autism connection which studies have had some mixed findings. I, personally, believe that Autism is a combination of more than one thing, like vaccines+overuse of antibiotics, or vaccines+heredity, or maybe vaccines+heredity+ overuse of antibiotics. It's this last one that I feel is the most likely because kids haven't changed that much, yet Autism is skyrocketing. What *has* changed? Both vaccine and antibiotic use has skyrocketed in the last 20 years.

    So, I think we need to put more effort into understanding what combination of things causes Autism and also to give vaccines in more reasonable ways (not 8 different vaccines in one visit). Finally, all preservatives (used to be mercury, now frequently aluminum or other nasty things) could be eliminated from vaccines if they stopped making multi-dose vials. We always insist on single-dose vials for our kids' vaccines, of the ones that we agree to give (but we spread them out over several weeks).

    Vaccines are a good thing, but we need to use our heads regarding them and a LOT more research needs to be put into Autism causes. It costs hundreds of thousands of dollars to care for a severely autistic person over the course of their life. Multiply that by figures as high as 1 in 200 and you can see that research into prevention would save billions.

    Posted by Al May 16, 08 01:47 PM
  1. My question is: How do you get the vaccination if neither doctors nor pharmacists will order it because of the difficulties of refrigeration? Does anyone know?

    Posted by Mary Sweeney May 16, 08 04:26 PM
  1. Question:I honestly don't know whether I ever had chickenpox, just lots of measels. Is it still safe, therefore, to have the shingles vaccine just in case?

    Posted by Dan & Kathy Kraft May 21, 08 10:09 PM
  1. I think you all need to lay off of "Beth". From reading her post, she is the one who has done her homework. When she states that more people may be getting shingles because of the varicella vaccine, it is because adults who had chickenpox as a child are no longer being exposed to chickenpox which is a natural immune system booster. Therefore, their immunity wanes over time, much more slowly than the coveted Merck Varivax, and they can then become more susceptible to shingles. Now that Merck is making their money off of Varivax, they can now start making their money off from Zostavax. Oh yeah, it only decreases the cases by half. In the end, Merck will have a steady income stream of people lining up for their varicella/zostavax boosters every 3-7 years.

    Posted by Kathleen May 23, 08 04:28 AM
  1. I am not going to go on a Beth rant, just want her to know that shingles just doesn't cause pain--it can kill. My husband, already immuno-compromised by cancer got shingles. His lymphoma was in remission. He was in a weakened state and shingles invaded his body. It attacked his brain, and lungs. He died in ten days. Shingles can kill and if there is an inoculation against shingles, I am getting it--actually next week I will receive my shot. So all nay-sayers should just get a life. Shingles Kills!

    Posted by Terry Beattie June 4, 08 11:41 AM
  1. I got shingles when I was in sixth grade. I was not immunocompromised as far as I remember. It was not terribly painful, more of a steady ache, but it left scarring on my face and infected my eye (no permanent damage). Will I be able to get the vaccine, or is strictly for age 60 and up? I am 37, under a lot of stress and would hate to have another outbreak. (For those of you wondering it was not impetigo, my Dr. did a culture)

    Posted by K. Weber June 4, 08 03:34 PM
  1. One of the retail health clinics will soon start offering the vaccing (Take Care) and the other(s) MinuteClinic may follow in the future.

    Beth posted a comment regarding her misunderstanding of the vaccine issues. I agree, stop harrassing her.

    Posted by Mary June 16, 08 08:17 PM
  1. I had shingles when I was just 18 and chicken pox as a child. Even though shingles were a MAJOR pain.....I would NEVER get an immunization to try and prevent them. I'll also NEVER have my child immunized for chicken pox. A lot of the vaccines out these days EXCEED THE ENVIRONMENTAL PROTECTION AGENCY'S GUIDELINES FOR LEVELS OF MERCURY. Yes, everyone freaks out when someone breaks a thermometer and mercury spills, and yet we INJECT MERCURY into ourselves and our children. Smart, America, Smart.
    Eat right the way God intended, take care of your body, reduce your stress, and guess what....your own immunity will take care of you.

    Posted by Denae June 28, 08 09:14 AM
  1. The price is NOT $15.00. A single dose is $152.50 and you get it for $145/dose if you buy 10 doses. (My doctor said it would be abot $160 and not covered by insurance.

    Posted by Dale June 29, 08 01:14 AM
  1. I didn't read all of the entries, so maybe my question was answered. Sorry!!!

    Would if you don't know if you had chicken pox, and everyone who would definitively know are dead. Would if your recollection, and that of your siblings is that we never had the chicken pox. I don't think I would want to put myself at risk for shingles, since I've seen some devastating cases of long term suffering and permanent affects.

    Should I get the shingles shot just to be safe? It's early and my doctor's office isn't open yet, thus I'm asking this question now.

    Thanks.

    Posted by Karen Gallagher July 3, 08 07:38 AM
  1. Unfortunately, children who have never had the chicken pox virus but have had the vaccine can also get shingles. The vaccine is made from the virus either weakend or dead. My 8-year old has just been diagnosed with an outbreak of shingles.

    Posted by Kathy July 3, 08 10:30 PM
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Elizabeth Cooney covers health for the Worcester Telegram & Gazette. She previously reported on business and was an editor at the paper. Earlier in her career, she edited medical books and journals at Little, Brown, and worked for Boston magazine.

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