Sunday, October 19, 2008

Shingles Vaccine- Is it worth getting?

Lately, I have been asked many questions about the Shingles Vaccine or as I will refer to it as Zostavax.
Shingles is caused by the reactivation of the Varicella zoster virus, the same virus that caused you to contract Chicken Pox infection as a child. Some of the causes of this reactivation include increasing age, weakened or altered immune system, physical stress and psychological trauma. Post-Herpetic Neuralgia is a painful condition affecting your nerve fibers and skin that may occur in 1 out of 8 individuals following a Shingles infection. While Shingles may last up to 3 weeks, Post Herpetic Neuralgia can last for many months or more. Luckily, developing Shingles or Post-Herpetic Neuralgia more than once is rare.
A picture of a Shingles rash is included below.
Shingles is not a communicable disease and if you receive the vaccine you have a chance of protecting yourself, but this will not transfer protection to your family, neighbors or community. In contrast, the full series of childhood measles vaccines will protect 99 of 100 children from measles and also will prevent the spread of measles to unvaccinated people in your community. Thus a big difference is that the Measles vaccine prevents initial infection and spread, while Zostavax tries to prevent the reoccurence of Chicken Pox as Shingles.
In the Shingles Prevention Study, Zostavax was found to decrease the annual incidence of Shingles by about 50% in individuals between the ages of 60-80, although the vaccine's long-term protective effects remains unknown. It is also believed that a booster would be necessary at 5-10 years post-vaccination. The vaccine was found to be much less effective in individuals 80 years of age and over and is not recommended for this age group. The side effects of the vaccine are mild and I will refer you back to the Zostavax web site for more information.
Insurance Coverage is also an issue with this vaccine as it is not cheap. The cost varies based on availability and has ranged from $200-300. As of October 2008, all Medicare Part D plans cover Zostavax. However, the amount of cost-sharing (money you have to pay) for the vaccination varies. Medicare Part B does not cover Zostavax. If you have private insurance, your plan may or may not cover the vaccine Please contact your insurer to find out.
If we accept the information contained in the population based Shingles Prevention Study, then if everyone between the ages of 60-80 received the vaccine, it would decrease the annual incidence of Shingles by 50%, or it would seem to protect 50 of 100 people, and it would also seem to reduce Post-Herpetic Neuralgia by about 66%, or 66 of 100 people.
Now let us look at Zostavax from an individual perspective. Shingles occurs in only about 1 out of every 100 individuals per year. So if we vaccinated everyone, the incidence of Shingles would drop by 50%, to about 1 out of every 200 individuals per year. So to prevent one Shingles case per year, we need to vaccinate 200 people. Sounds good for that one person, but how about the other 199? By using the same logic, we would need to vaccinate 7,500 people to prevent one case of Post-Herpetic Neuralgia per year.
If you are between the ages of 60 and 80 and receive Zostavax, your absolute risk of developing Shingles will be reduced from 1% per year to 1/2 of 1%. Your chance of developing Post-Herpetic Neuralgia will be reduced from 0.13% to 0.08%.
So the choice is yours, and there is no right or wrong choice, just an informed choice!
Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness

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