Do you need the shingles vaccine?

Doctor Giving Senior Female Patient Injection

If there were a simple shot to prevent a common, debilitating virus that targets people over age 50, wouldn’t folks be clamoring to roll up their sleeves? Well, there is such a vaccine: Zostavax, which the U.S. Food and Drug Administration (FDA) says reduces the risk of developing shingles by up to 70 percent.

I had the blistering shingles virus a few years back and would not wish it on my worst enemy. Before getting shingles, I thought it was a simple illness that only “old people” got. Perhaps this was from hearing my country kinfolk talking about an aunt or neighbor “being down with the shingles,” as if it were a common cold.

Shingles is common, but it’s exponentially worse than a cold. “Being down” with shingles is a good way to describe it, because it will indeed bring you down.

The disease, also known as zoster or herpes zoster, is caused by the varicella-zoster virus, which also causes chickenpox. (Oh, and just to clear up a major misconception: Herpes zoster is not caused by the same virus that causes the sexually transmitted disease, genital herpes.)

Some people might underestimate the suffering brought on by shingles — until they’ve felt the stabbing icepick-to-the-nerve pain that accompanies an attack. Those who know how real this pain can be are trying to figure out why people who could be vaccinated are shying away from the shot.

The U.S. Centers for Disease Control and Prevention (CDC) has been recommending the shingles vaccine for most men and women over age 60 since 2006, when the drug earned FDA approval for that age group. Five years later, Zostavax was approved for ages 50 to 59, though the CDC hasn’t yet made a blanket recommendation for that age group.

Researchers at The Ohio State University College of Pharmacy found that roughly 85 percent of those recommended to get the shingles vaccine aren’t doing so, according to a study just published in the American Journal of Medicine. A combination of factors was cited for the low vaccination rate, including lack of awareness, cost, access to clinics able to store the fragile vaccine and not enough time during doctor appointments to discuss shingles.  

Soraya Nasraty, M.D., medical director for Norton Immediate Care Centers, agreed that only a small number of eligible patients get the vaccine.  

“One of the main reasons is the fact that insurance historically hasn’t covered all of it and the patient had to pay a large portion,” Dr. Nasraty said. “It is not so much about physicians not having time to discuss it with patients, but more about the cost.”   

The shot can run upwards of $300, which often must be paid completely by the patient, depending on their insurance coverage. Dr. Nasraty said she thinks coverage could improve this year, under the national health insurance overhaul.   

Patients who received written information on shingles were almost three times more likely to get vaccinated than those who didn’t receive a similar communication, the Ohio State study found.

About half of those who get shingles are age 60 or older, according to the CDC. A weakened immune system and stress are thought to be major triggers for the disease, which hits one in three people and roughly 1 million annually. Peak season is winter.

Virtually all adults harbor a dormant form of the varicella-zoster virus in their nervous system, and it later can re-emerge in the form of shingles, according to the CDC. One to five days before you know what’s hit you, there is often pain, itching or tingling in an area that will soon errupt in an angry red rash.

A tell-tale sign that it’s shingles: The rash is only on one side of the face or body, often in a single stripe from mid-torso to mid-spine. The rash forms blisters that typically scab over in seven to 10 days and clear up in two to four weeks. Throughout its duration, other symtoms can include fever, headache, upset stomach and chills.

My symptoms matched those outlined on the CDC Shingles Homepage. People who think they might have shingles are urged to contact their health care provider as soon as possible, because there are several antiviral medicines that can shorten the length and severity of the disease if they’re started soon after the rash appears. Cold compresses, analgesics and other prescription drugs also may help relieve the pain.

Despite getting prompt treatment, I ended up with what the CDC says is the most common complication of shingles — a condition called post-herpetic neuralgia (PHN). PHN causes severe pain where the shingles rash was, for weeks, months or even years after the rash clears up. Older patients are more likely to develop PHN and to have the worst pain. Other rare complications include pneumonia, hearing problems, blindness, brain inflammation (encephalitis) and death, the CDC reports.

Not everyone who falls into the FDA-approved age group can get the shingles vaccine, because of allergies or certain other situations.

Dr. Nasraty recommends people age 50 and older talk to their health care provider to clear up any questions or concerns, such as my burning question: Can you get shingles more than once?

The answer, she said, is yes — though it is rare. And yes, the vaccine is approved for people over age 50 who already have had shingles.

–Mickey Gramig