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Vaccine can reduce the risk of shingles

It’s a vaccine that cuts in half the chances of getting a painful and debilitating disease, it’s a vaccine that needs to be administered only once, and it’s a vaccine well-tolerated by most of the people who need it.

Yet, relatively few of the older Americans who could benefit from Zostavax — a vaccine that can prevent shingles, a painful skin and nerve condition — have taken it.

A primary reason is the relatively high cost of the vaccine. Still, medical professionals say that asking their doctors about receiving a Zostavax vaccination should be a prime entry on the medical to-do lists of just about everyone age 60 and older.

Think of shingles, which also is referred to as herpes zoster, as the meaner, more patient cousin of chickenpox. In fact, both shingles and chickenpox — a malady most of us figured we had put behind us long ago in childhood — are caused by the same virus, varicella zoster.

"When you get chickenpox as a kid, you get that infection and your body contains it," says Dr. John Varras, interim chairman of the University of Nevada School of Medicine’s internal medicine department.

After the bout of chickenpox passes, the varicella zoster virus remains, lying dormant in the body for decades. The virus may, in some people, reactivate, manifesting itself in the form of shingles.

Shingles — most common in people 50 and older — typically causes a painful skin rash, often accompanied by blisters, that may appear on one side of the face or body. The pain of shingles "actually comes from the nerve endings," Varras notes. "The virus lays latent in the nerve, and when it becomes active, it forms this painful rash."

In someone with a healthy immune system, the rash usually resolves itself in seven to 10 days, Varras says. And, the shingles sufferer may experience recurrent periodic bouts of shingles, or may never have another shingles outbreak.

In rare cases, a bout of shingles can lead to such complications as pneumonia, blindness, hearing problems or encephalitis. More often, but still not all the time, shingles can lead to a condition called postherpetic neuralgia, in which the pain of a shingles attack continues even after the rash itself has disappeared.

Not only is postherpetic neuralgia "pretty painful," Varras says, "it can last a long time. I’ve seen patients who have had it from a number of months up to a year."

In 2006, Zostavax was licensed for use as a shingles vaccine. In clinical trials, according to the U.S. Centers for Disease Control and Prevention, the vaccine reduced the risk of shingles in people age 60 and older by about 50 percent and the risk of postherpetic neuralgia in that same age group by about 67 percent.

Two years ago, a federal immunization advisory committee recommended that everyone age 60 and older receive the vaccine, which is administered in a single dose.

Richard DiCarlo, a certified physician assistant and market manager for Take Care Clinics, which operates 14 primary care health clinics inside Las Vegas Valley Walgreens stores, notes, too, that the vaccine can prevent a shingles attack in someone who already has had one.

"That’s very important to note," he says. "Once someone has had it, it’s still applicable for them to get the vaccine."

Yet, for all of the benefits the vaccine seems to offer, one study found that, during the first two years the vaccine was available, fewer than 10 percent of people 60 and older had received it.

"Patients are really getting under-vaccinated for it," Varras says.

Dr. Steven Evans, chief medical officer and pharmacy director for UnitedHealthcare Nevada — the company’s medical insurance plans include Senior Dimensions and Health Plan of Nevada — agrees.

"I think there probably is an unmet need there for increased awareness" of the vaccine, says Evans, adding that "I do, in fact, see patients who come in with shingles and invariably haven’t had the vaccine."

Granted, the vaccine isn’t ironclad protection against shingles. It is, Evans notes, "only 50 percent effective, so you can get the vaccine and still get shingles."

But, Evans adds, because shingles is such a painful and potentially debilitating condition, "if you can reduce it by 50 percent, that’s a good thing. So I think there is an unmet need to get more people vaccinated."

One of the "biggest challenges" to more widespread vaccination is the cost of a Zostavax vaccination, Varras says.

He notes that patients have told him of paying more than $200 for a vaccination. DiCarlo says the cash price for a shingles vaccination at Take Care Clinics is about $219. And, at the Southern Nevada Health District, where the shingles vaccine is available through the district’s immunization clinic, spokeswoman Jennifer Sizemore says the $180 charge "just covers our cost of providing the vaccine."

On the upside, at least for older seniors, the CDC says all Medicare Part D plans include the shingles vaccine, although the actual out-of-pocket charge a Medicare-covered senior will pay will vary. But, notes Dr. Laura Addis, a Las Vegas internal medicine physician, even if a medical plan does cover a shingles vaccination, some have high deductibles or co-pays "that prohibit people from getting it."

Out-of-pocket health care costs are "very significant with people on fixed incomes," Addis says. "We spend a lot of time fighting with them to take their blood pressure medication, and they tell me they can’t afford a $10 co-pay. And, now, they have to try to come up with a couple hundred dollars for this."

Evans notes that, particularly at a time when many patients are "having trouble economically, a vaccine that doesn’t necessarily treat something you’re having at the moment is usually not at the front of people’s thoughts."

One option, according to Sizemore, can be a program offered by Merck & Co., the manufacturer of Zostavax, that assists people without insurance or prescription medicine coverage (for information, visit www.merck.com/merckhelps/vaccines/).

But, financial considerations aside, it’s a good idea for those 60 and older to ask their doctors about whether the shingles vaccine would be beneficial for them. (It isn’t, for example, recommended for those with weakened immune systems from, say, HIV/AIDS or cancer treatment regimens.)

Shingles and postherpetic neuralgia are "devastating illnesses," Evans says. "They are among the most painful illnesses you can get. So I would definitely recommend people getting this if they’re of the correct age, to reduce their chances of getting those diseases."

Contact reporter John Przybys at jprzybys@ reviewjournal.com or 702-383-0280.

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