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The shingles vaccine: Why hasn’t it caught on?

When the FDA approved Zostavax in the spring of 2006, it seemed like the shingles vaccine was going to make a big splash. The large clinical trial that the agency based its approval on showed that the vaccine halved the risk of getting shingles. Even more impressive, it cut by two-thirds the risk of developing postherpetic neuralgia, the aftermath of shingles that develops in about one in every three cases in people age 60 and over. Shingles can be very uncomfortable. In addition to the bad rash, a case may involve severe pain, fever, an upset stomach, or headaches. But the pain from postherpetic neuralgia can make life miserable for months, even years.

You’d think that any vaccine that could spare people from this would be welcomed with open arms — and rolled-up sleeves. But it hasn’t quite worked out that way. Doctors and health plans haven’t pushed it. Some patients have had a hard time getting it. There’s some confusion about whether people who have already had shingles should receive it. And for a vaccine, it’s expensive.
Here are some of the problems that the shingles vaccine has run into:

Maybe not a great deal after all. Merck is charging about $150 for the one-shot vaccine. Doctors and hospitals charge a mark-up, so the total bill can come close to $300. In comparison, the standard flu vaccine costs between $11 and $15, and the pneumococcal vaccine, about $25. Traditionally, vaccines are one of the best health bargains out there — a low up-front cost that pays for itself many times over in averted sickness and early death. But vaccine costs are going up, so the economics aren’t so clear-cut anymore.

Spotty insurance coverage. Zostavax is approved for people 60 and older, so Medicare coverage is a major issue. It’s up to each individual Part D prescription plan to decide whether the shingles vaccine should be on its formulary.

Questionable value for people who have had shingles. If you’ve had a bona fide case of shingles, the chances of getting another one are extremely low. For that reason, Kaiser Permanente, the California health plan, decided not to offer the vaccine to people who have had shingles.

Logistical problems. Zostavax must be stored at a temperature of 5° F (−15° C). Most doctors who see adult patients don’t have a freezer that will keep the vaccine that cold, so some hospitals have set up centralized by-appointment-only Zostavax clinics, staffed by pharmacists. For patients, this can mean making an additional trip to the hospital.

Lack of urgency. Vaccines have traditionally targeted communicable diseases, so getting immunized has a social purpose: You’re protecting yourself and others that you might infect with a contagious disease. People with shingles can infect others with the herpes virus that causes the disease (the result is chicken pox, not shingles). Still, shingles is less contagious — and far less lethal — than flu, measles, and many other diseases we get vaccinated for.

Did the FDA play down the benefits? One of the most impressive results from the Shingles Prevention Study that led to approval of the vaccine was the two-thirds reduction in postherpetic neuralgia. But the two-thirds figure — more precisely, 67% — doesn’t appear anywhere in the FDA-approved information about Zostavax.

Should you get the shingles vaccine?

You can’t get shingles unless you’ve first had chicken pox. Currently, more than 90% of adult Americans have had chicken pox, and about one in three will get shingles some time in their lives. The vaccine cuts the risk of developing shingles by half.

Your age is a consideration. The vaccine is approved for people 60 and over. The likelihood of getting shingles increases with age. But there’s the rub, because the older you are, the less effective the vaccine is against shingles. It was actually more effective in preventing postherpetic neuralgia in people 70 or older than in those ages 60 to 69.

Finally, there’s the cost to consider. If you want the vaccine, you need to check whether it is covered by your health plan or Part D Medicare prescription plan first.

September 2007 update

Boost Immune System
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The Truth About Your Immune System

Your immune system is your most powerful protector against disease. But it’s not fail proof. The Truth About Your Immune System describes how your immune system works, what happens when it fails, and what you can do to give it a boost in battling disease. Read more

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