Information about the Shingles Vaccine

Herpes zoster (or zoster), commonly known as shingles, is a viral disease characterised by a painful skin rash with blisters in a limited area on one side of the body. It results from the reactivation of latent varicella zoster virus - the virus that caused chickenpox in the person as a child remains dormant for many years until it is reactivated by stress, low immunity or often just for spite! Although the rash usually heals within two to four weeks, some sufferers experience residual nerve pain for months or years, a condition called postherpetic neuralgia.

Treatment of shingles usually involves an antiviral medicine (like acyclovir, Valtrex or Famvir) with or without prednisone. Treatment is more effective if it is started within the first few days. After 3-5 days, treatment with any medicine is far less likely to be helpful. One of the most troublesome complications of shingles is that pain that lingers for weeks, months or even years. Treatment of the acute infection within a few days of onset of the rash clearly helps to reduce the postherpetic neuralgia, but even appropriate treatment in the specified window of 3 days may not prevent longterm pain. Hence, development of a vaccine to PREVENT shingles is seen by many as a great advance.

Zostavax is the name of the vaccine. It can be used in anyone aged 60 years or older. As of January, 2008, it costs about $180 per dose. It must be kept frozen prior to administration (so if you buy it from a pharmacy, you just keep it in a cooler until it is administered by your physician; however, many pharmacies offer "Vaccination Clinics" once per month or so). The vaccine is not perfect: it is about 64% effective in preventing shingles in patients 60-69, and 38% in those over age 70. The vaccine is still recommended in patients who have had shingles in the past, though there have been no studies done on vaccine effectiveness in this population. To make a decision about whether the vaccine is right for you, the next most important piece of information is "How likely am I to get shingles???"

A study in 2007 by the Mayo Clinic can help us answer that question. For people younger than age 50, the risk was about 2 per 1000-person-years (this means that only 2 people out of 1000 would be expected to get shingles in a given year at age 50). The risk for those aged 50-59 was 5 per 1000-person-years, and for those aged 60-69 the risk was 7 per 1000-person-years, and for those aged 70-79 the risk was 10 per 1000-person-years, and for those aged 80-89 the risk was 12 per 1000-person-years. About 18% of people getting shingles can expect to have pain for more than 1 month (that is about 1 in 5 people). So, should you get the vaccine? The side effects are minimal (a few people end up with a mild chickenpox rash after vaccination, and some people complain of redness or pain at the site of the injection). The decision is up to you. Are you willing to risk the 0.5 to 1.2% risk of getting shingles this year, with a 1 in 5 chance of having pain for more than a month?