Shingles Vaccine May Be Worth Cost

By Peggy and Terry McDannold

Chickenpox was a common viral illness that most of us over age 50 endured when we were kids. One unusual thing about the virus that caused this illness is that after the chickenpox resolved, the virus remained in the nervous system of our bodies in a dormant state.

Years pass, we feel fine and suffer no consequences from this virus as it lies dormant. However, for unclear reasons, the virus reactivates in some people and can cause a variety of diseases that can damage the nervous system.

Unusual neurologic manifestations of this virus becoming active include: stroke, myelitis (inflammation of the spinal cord), meningitis, encephalitis or retinal inflammation with visual loss. The most common disease caused by reactivation of the virus is shingles (herpes zoster).

Shingles tends to occur more often in patients as they age and their immunity declines. Other causes of immune deficiency, such as cancer chemotherapy, high dose steroids or AIDS can increase the risk of developing shingles

Many of you are familiar with this disease. It is characterized by a painful red rash that develops blisters within a day or two. Zoster also is characterized by occurring only on one side of the body. The rash can be present on any part of the body. The most common site is the chest. The face is the next most common site for shingles.

Most rashes don’t hurt. Most rashes occur on both sides of the body. If you develop a painful rash affecting only one side of your body — odds are it is shingles.

If you notice such a rash, see your doctor as soon as possible. The rash itself doesn’t usually cause a big problem, but the patient can be left with severe pain for months to years (post herpetic neuralgia). If the patient is started on antiviral drugs soon after the development of the rash, the speed of healing of the rash is improved. More importantly, the chance of getting post herpetic neuralgia is decreased by starting these drugs quickly.

Patients who develop shingles involving the face are at higher risk of developing a severe case of post herpetic neuralgia. They are often also treated with prednisone 60 mg per day for three to five days in the hope that this will decrease their risk of post herpetic neuralgia.

This is especially important in patients over age 50. Older patients have a higher incidence of post herpetic neuralgia. More than 40 percent of patients older than age 60 with shingles develop post herpetic neuralgia.

Post herpetic neuralgia can cause severe debilitating pain for months to years. There are a multitude of treatments for this painful syndrome. Narcotics, Neurontin, Lyrica, antidepressants and/ or lidocaine patches are prescribed for some patients. However, even with these treatments some patients remain in severe pain. There are even some reports of suicide related to the severe pain of post herpetic neuralgia.

Recently a shingles vaccine (Zostavax) has been developed. It is recommended for all people over age 60, including those who have a history of shingles. Like all vaccines it is not 100 percent effective. The vaccine will decrease the occurrence of shingles by 50 percent. It should prevent post herpetic neuralgia in about 66 percent of persons receiving the vaccine.

The biggest problem with the vaccine is the cost — $186. Not all insurance plans pay for the vaccine. Some Medicare plans will pay for the vaccine, but currently the payment schedule is complex.

Peggy and Terry McDannold, who live on a farm in Campbell County, are doctors as well as husband and wife. Both practice internal medicine in Northern Kentucky. E-mail them at pairofdocs@gmail.com.

(c) 2007 Cincinnati Post. Provided by ProQuest Information and Learning. All rights Reserved.