A vaccine to prevent shingles was approved by the FDA in May 2006 for use in people age 60 and older. As you may know, shingles is caused by the herpes zoster virus that is also responsible for chicken pox. The virus can lie dormant in the body for many years after a case of chicken pox and then reactivate for unknown reasons to stage a new attack. If you've had chicken pox, you have a 10 and 20 percent chance of someday developing shingles. The risk increases with age: of the one million cases that occur in the United States every year about half are in people over 60.
Shingles is no fun. It usually begins with an itch, a tingling sensation, or a stabbing pain, usually on the surface of the skin of the torso or the face. A few days later, a rash develops. It runs along the course of a nerve root on one side of the body and turns into small, fluid-filled blisters that then dry out and crust. At its peak, the outbreak can cause intense pain. Some people get over shingles quickly, but a severe attack can prolong its course over three to five weeks and leave some unlucky individuals with residual pain lasting months or even years after the lesions disappear; this condition is called postherpetic neuralgia.
The new vaccine, Zostavax, isn't perfect – it works about 50 percent of the time. More than 38,000 people over 60 who never had shingles participated in clinical trials of the vaccine. About half of them got the vaccine while the other half got a placebo shot. After three years, those who didn't get the shot developed about twice as many cases of shingles as those who received the vaccine. So the shingles shot can cut the risk in half, not eliminate it entirely (however, those people who developed shingles despite receiving the vaccine had less severe cases than did those who got the placebo). Although Zostavax prevented shingles only 51 percent of the time, it did prevent postherpetic neuralgia in 67 percent of the people studied. The vaccine seemed to be most effective in people 60-69 years old but also provided some protection for older groups.
Side effects were mostly redness, soreness, swelling or itching at the injection site and headache. The shot, which is available now, is a bit pricey: it costs about $150, and that's without the doctor's charge to administer it. If you're in a state that allows pharmacists to give injections, you may be able to save some money by getting your shot at the drug store.
Having had an unpleasant case of shingles this summer, I'm inclined to recommend the vaccine for those at risk, especially since the disease seems to be becoming more prevalent.
Andrew Weil, M.D.
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