Getting Shingles Vaccine Can Be Complicated Task

By Elizabeth Simpson, The Virginian-Pilot, Norfolk, Va.

Apr. 24–Being a retired doctor, 80-year-old Robert Morton well remembers treating patients for the painful rash of a disease commonly known as shingles.

“It can change you from a vibrant, active person to someone who is almost a recluse,” he said.

So when his physician, Dr. Kevin Murray, told him about a vaccine that could prevent him from getting the disease, or lessen its effects, he asked to think about it.

“After about a minute, I said yes,” said Morton, who used to practice internal medicine in Norfolk and still lives in the city.

The vaccine is called Zostavax, produced by Merck & Co. The Food and Drug Administration approved it last May, and an advisory committee to the federal Centers for Disease Control and Prevention recommended it for people 60 and older in October.

Although there ha s been interest in the vaccine — spurred in part by full-page advertisements by Merck — getting it has been a challenge for some patients. Not all insurance companies cover the vaccine, and it’s expensive.

The vaccine costs about $150, and doctor’s offices also can charge a fee for administering the injection.

Medicare, the federal insurance for people 65 and older and the disabled, has authorized coverage of the vaccine under its Part D prescription coverage. But dozens of insurers offer Part D plans in Hampton Roads, and what they are willing to cover for patients varies.

Some doctors in South Hampton Roads aren’t offering the vaccine yet. A few are stocking it and either billing patients directly or billing their insurance companies. Still others are asking patients to pick up the prescribed vaccine — which must be stored frozen — at a pharmacy, then come directly to their offices so a nurse can inject it.

Murray, a Norfolk internal medicine doctor who also specializes in geriatrics, said he’s been advising his patients who are 60 and older to get the vaccine. His practice stocks it, and he asks patients to first check with their insurance to make sure it’s covered.

In a typical year, an estimated 1 million people in the United States get shingles — known medically as herpes zoster. The rash is caused by the same virus that causes chickenpox, which occurs most often in childhood. Once someone recovers from chickenpox, the virus lies dormant in nerve tissue cells.

When people get older, their immune systems weaken, and the virus can flare up again in the form of shingles, a rash that develops into clusters of blisters that usually appear on one side of the body or face.

The rash is often painful, and sometimes is accompanied by fever, upset stomach, headaches and chills. In rare cases, shingles can develop into blindness, hearing problems, pneumonia and even death. Usually, though, the rash clears up within a month.

The rash often appears on the skin along the path of a particular nerve, which gives it the look of a shingle and thus its name. In about 20 percent of cases, pain continues even after the rash clears up, according to Dr. Rex Biedenbender, a geriatrician at Eastern Virginia Medical School. This pain is called postherpetic neuralgia and can last weeks, months, even years.

In a study of 38,000 people, Zostavax was reported to have prevented shingles in 50 percent of those who received the vaccine. Those who did develop shingles with the vaccine had shorter periods of pain, researchers said.

The researchers will follow the subjects for 10 years to monitor complications, which so far have included minor soreness at the injection site and headaches, and to measure length of immunity.

The shingles vaccine is a weakened live virus and is not recommended for people with a compromised immune system from HIV, AIDS or cancer treatment, or those with active, untreated tuberculosis.

Sentara Medical Group, a system of doctor practices throughout Hampton Roads, has been giving the vaccine since July. Kim Hartman, director of operations for one of the group’s three practices in the Wainwright Building in Norfolk, said nurses there have been giving about 44 doses a month. Overall, the network is administering about 130 a month.

Julie Burnette, practice administrator at Granby Internal Medicine in Norfolk, said that practice ordered 80 doses last fall, and have used 21. At that practice, Medicare patients pay for the vaccine, then receive a form from the office to file for reimbursement through their insurance companies.

— Reach Elizabeth Simpson at (757) 446-2635 or elizabeth.simpson@pilotonline.com.

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Copyright (c) 2007, The Virginian-Pilot, Norfolk, Va.

Distributed by McClatchy-Tribune Business News.

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