Post

Shingles Vaccine Protects Many
AARP Bulletin

If you had chicken pox as a child — and most of us did — then you’re at risk for getting an excruciatingly painful rash called shingles as a 60-plus adult.

The good news: A new study says the shingles vaccine is even more effective than previously thought at cutting your risk.

And the bad news: Hardly anyone can get the vaccine.

Shingles, or Herpes zoster, is a virulent rebound of the chicken pox virus, which lies dormant in the spinal cord’s nerve roots and can flare up during times of stress or illness when we’re older.If left untreated, shingles can cause long-lasting pain and nerve damage, especially among those in their 80s.

A new study of more than 300,000 older adults, published [January 2011] in the Journal of the American Medical Association, found that the shingles vaccine cuts that risk by 55 percent.

Even better, the study showed that the vaccine is effective in preventing ophthalmic shingles — a particularly dangerous manifestation of the virus that can damage eyes and even cause blindness.

The researchers, who conducted the study from 2007 to 2009 among patients with Kaiser Permanente in Southern California, also found that the vaccine helped those 79 and older — the age group most likely to get shingles and to be most severely affected by its side effects.

“This vaccine has the potential to annually prevent tens of thousands of cases of Herpes zoster,” the researchers wrote in the study’s conclusion.

Study coauthor Rafael Harpaz, M.D., a medical epidemiologist with the federal Centers for Disease Control and Prevention (CDC), added in an interview that the benefits could even be higher: “Half a million adults 60 and older get shingles annually. The vaccine could cut that number in half.”

Just one problem: Only a paltry 10 percent of seniors get the vaccine because of what Harpaz calls a frustrating “witches’ brew” of barriers. First and foremost, drug company Merck hasn’t been able to manufacture a steady supply of the shingles vaccine. Shortages were a problem throughout 2010, and currently the company’s website says the vaccine is back-ordered and won’t be available until April or May.

And then there’s the cost, which can range from $160 to $300 if your insurance doesn’t cover it, and many plans don’t. Although the shingles vaccine is covered under Medicare Part D, the government plan makes it easy only if you get your shot in a pharmacy (assuming you can find one that stocks it). If you want to get the vaccine in your doctor’s office, Medicare makes it more difficult.

“The Medicare Part D partnership is with pharmacies, not physicians, so if people get the vaccine at a pharmacy, it’s relatively seamless,” Harpaz explains. “But if they want to do it at their physician’s office, they either have to pay full cost and then file to get reimbursed, or the physician sends them to the pharmacy to get the vaccine and bring it back, to which the CDC is very opposed” because the vaccine must remain frozen.

Finally, not many older adults and their doctors even know about the vaccine. Unlike the publicity surrounding the flu vaccine, the shingles vaccine has had a much lower public profile.

“The fact that it’s not been marketed is directly tied to the supply shortage. They don’t want to overpromise and get people angry,” says Harpaz.

A person’s lifetime risk of getting shingles is about 30 percent, and those odds increase with age, say researchers. “The risk of getting shingles by age 85 can be 50 percent,” says the study’s lead author, Hung-Fu Tseng, a research scientist with Kaiser Permanente.

A 2005 shingles study found the vaccine to be less effective in those 79 and older, but the new study found that it lowered the risk of shingles in patients of all ages including the oldest population, Tseng wrote. Because shingles tends to be more debilitating for those in their 80s, it makes plenty of sense to give the vaccine to the oldest seniors, adds Harpaz.

There’s also another reason for seniors to get the vaccine, he says. Older adults who got shingles even after getting the vaccine experienced milder symptoms and a shorter period of pain. The vaccine also reduced the risk of hospitalization and more severe complications.

The benefits are clear, he says. Now, if only the vaccine were actually available.

Update: Rite Aid has announced that nearly 1,900 of its pharmacies have the shingles vaccine in stock. To find a Rite Aid location near you, go to www.riteaid.com/shingles and enter your zip code. Patients should call first to see if appointments are necessary and for the cost, which varies with insurance coverage. Rite Aid pharmacists can administer the vaccine in 27 of the 31 states where the pharmacies are located; in Massachusetts, New Hampshire, New York and West Virginia, state regulations require the pharmacy to hold scheduled clinics.

Commands