By John M. Weigand, M.D.

Director of Geriatric Services

Central Ohio Geriatrics

Of the more recent “medical advances” available, patients have asked more about the shingles, or herpes zoster, vaccine than any other. Perhaps you have heard about it in the news or from friends and family, but in my experience as a physician who cares for the elderly, the No. 1 reason someone asks me about it is because they know someone who has had shingles!

Shingles or herpes zoster is a painful skin rash that is caused by the varicella-zoster virus, the same virus that causes chickenpox. It is important to note that this is not the same virus as the one that causes herpes simplex, which can be either a cold sore or sexually transmitted. In people who have had chickenpox, the virus is never fully cleared from the body and can remain dormant in the body for years. Emotional and physical stress has been shown to weaken the body’s immune system, which can reactivate the virus, causing it to spread via nerve fibers to the particular area of skin supplied by that nerve. The first sign of shingles is usually described as a “tingling”, “burning” or even a “numbness” or “itch,” in one particular location on only one side of the body. The rash of shingles usually develops after one to two weeks and is typically localized to one side of the body along the distribution of the affected nerve (known as a dermatomal distribution).

The shingles vaccine, also known as Zostavax, contains a weakened chickenpox virus (varicella-zoster virus) and helps stimulate the immune system, which helps prevent getting shingles in people age 60 and older. In scientific studies, the shingles vaccine reduces the risk of developing shingles by about 50%. Findings also show that the shingles vaccine can shorten the duration of the nerve pain, called postherpetic neuralgia. Postherpetic neuralgia is extremely painful and can last anywhere from 30 days to months and even years after the rash has resolved. The risk of neuralgia is reduced by about 60% by the shingles vaccine.

Another important benefit of the shingles vaccine is that it helps prevent the spread of the virus to other people. Because shingles is a contagious viral infection, the shingles vaccine works to stop the spread of the virus just like childhood immunizations for measles, mumps and rubella or varicella. A person who has shingles can pass the virus to someone who has never had chickenpox and the newly infected person can develop chickenpox, not shingles.

The Centers for Disease Control recommends a single dose of the shingles vaccine for people age 60 and older, even if they've already had a bout of shingles. Of the approximately 50 million Americans older than 60, more than 95% had chickenpox as children, which means millions of older adults are vulnerable to shingles.

According to the CDC, the following people should not get a shingles vaccine:

• People who have had a life-threatening allergic reaction to gelatin, the antibiotic neomycin, or any other component of the shingles vaccine. Tell your doctor if you have any severe allergies.

• People with a weakened immune system because of HIV/AIDS or active tuberculosis, treatment with drugs that affect the immune system, such as steroids; cancer treatment such as radiation or chemotherapy; a history of cancer affecting the bone marrow or lymphatic system, like as leukemia or lymphoma; or who might be pregnant. The CDC recommends that women should not become pregnant until at least three months after getting shingles vaccine. (I have always wondered how many women older than 60 are interested in becoming pregnant, but I digress!)

An important consideration regarding whether the shingles vaccine is right for you involves insurance coverage. The cost of the vaccine is relatively expensive — $150-$200 — and is covered under the Medicare Part D program. This means most people need to purchase the vaccine and their health insurance providers will reimburse them. Patients should check with their insurance providers to see if this is a benefit they provide. Some people, especially those who have had shingles or know someone who has had this condition, are willing to pay for the vaccine if it decreases their chance of suffering from this rash or the possibility of postherpetic neuralgia.

Some physicians might offer "off-label" shingles vaccines to patients age 50 to 59 in hopes of providing earlier protection against shingles. "Off-label" refers to drugs that are used in ways that have not been approved by the FDA. Keep in mind that researchers still don't know how long immunity lasts with the shingles vaccine and insurance companies do not usually pay or reimburse for off-label use of medications or vaccines.