June 5, 2012 in Features, Health

Staving off shingles

With vaccine now available to people over 50, sufferers would be the first to say don’t worry about cost and act now
By The Spokesman-Review
 
Risk increases

with age

 Shingles is a skin rash, often with blisters, caused by the varicella zoster virus, which also causes chickenpox.

 The virus stays in your nerve cells even after chickenpox clears up and can reappear years later. So if you’ve had chickenpox – and 99 percent of people 40 and older have, even if they don’t remember it, according to the Centers for Disease Control and Prevention – you could get shingles.

 For some people, their onset might be provoked by stress. For others, shingles seems to come out of the blue.

 And while people any age can get it, your risk increases as you age. That’s because our immune systems tend to weaken as we grow older. People who have medical conditions that keep the immune system from working properly – such as HIV or certain cancers – also face higher risk.

When it comes to shingles, other people’s horror stories are sometimes the best preventive medicine.

Sufferers – most often people 50 and older – use terms like “excruciating” and “debilitating” and “fire” to describe the blistery skin rash. Some go blind, the rash having invaded their eyes. And while the symptoms fade within weeks for some, others live with the pain until they die, the touch of a shirt against their skin agonizing.

People seeking the shingles vaccine, called Zostavax, often report it was pain of friends or relatives that compelled them to act, pharmacists say.

“If (customers) really know someone who’s had it, they don’t even flinch at the price,” said Chris Greiner, a pharmacist who runs the clinical department for Albertsons pharmacies in the Northwest, which administered 9,000 doses in the fiscal year that ended in February. That was a 50 percent increase over the previous year, Greiner estimated.

Sales are up all over, and word of mouth is just one factor leading more people to the pharmacist’s counter. Merck, the vaccine’s only manufacturer, says its supply problems are resolved, and this spring it launched a national ad campaign to raise awareness of shingles. A study touting the vaccine’s safety made headlines in April.

And, at least as far as the Food and Drug Administration is concerned, 50 is the new 60 when it comes to the vaccine. Formerly approved for people 60 and older, it has the FDA’s OK for people 50 to 59, too.

Add it all up, and more people are getting the shot. In 2010, 14 percent of people 60 and older had gotten the vaccine, compared with 10 percent in 2009, according to the Centers for Disease Control and Prevention. And Zostavax sales totaled $332 million in 2011, a 37 percent increase over 2010, Merck reported.

Considering that nearly one in three people will get shingles over their lifetime, according to the CDC, the vaccine stands to prevent a lot of excruciating pain. At the same time, the CDC – running counter to the FDA – decided against recommending the vaccine for that younger group. The vaccine’s high cost also may deter some people.

‘Pretty much immobilized’

For Hayden resident Janet Javorka, the red spots on her arm – and the pain – extended from her right fingers to her right shoulder. She couldn’t hold a pen, she said, much less her newborn great-granddaughter.

It was six years ago, but she remembers it well. Her shingles lasted two months.

“I tried all kinds of pain medications, and nothing worked,” said Javorka, who’ll turn 79 on Wednesday. “I would get up and sit around in a chair. I was pretty much immobilized.”

Shingles is caused by a virus that lies dormant in the nerve cells of anyone who’s had chickenpox, which is nearly every adult.

The pain is what sufferers mention most. But shingles can cause other serious problems, too, said Dr. Bill Lockwood, director of Spokane Urgent Care on North Lidgerwood Street.

“Shingles is bad for a whole lot of reasons,” Lockwood said.

If it involves one or both eyes, it can threaten your vision. The lesions can become infected. Potential neurological complications include encephalitis.

The rash and the pain have usually faded by six weeks. But some shingles sufferers develop nerve pain that continues long after the rash is gone, sometimes forever.

While “direct-to-consumer” drug ads can lead to inappropriate prescriptions of some medications, in this case the effect of Merck’s campaign may be positive, Lockwood said, if it raises awareness of the vaccine.

If you’re 60 or older and get the vaccine, you’re 51 percent less likely to get shingles, he said. And if you do get the rash after getting the vaccine, you’re 67 percent less likely to develop post-herpetic neuralgia, the long-lasting nerve pain.

“That pain can last weeks or months or years, and the older you are, the longer that pain can last,” Lockwood said.

Approved for younger group

The shingles vaccine was approved for use in people 60 and older in 2006, and the FDA approved it for 50- to 59-year-olds a year ago. The agency cited the incidence of shingles among that younger group, saying about 200,000 healthy people ages 50 to 59 get it every year.

But a few months later, a CDC panel declined to recommend the vaccine for that younger group, despite the FDA’s approval. The CDC still recommends the vaccine for those 60 and older.

The CDC panel cited limited information about the vaccine’s effectiveness over the long term.

The vaccine is now administered as a one-time dose – no follow-up shots needed. But that could change, Spokane pharmacist Steve Webbenhurst said, if researchers see that the vaccine’s effectiveness weakens among the younger group.

“As time goes on, we’ll see if that immunity stays with people as they age into their 70s, 80s and 90s,” said Webbenhurst, who works at the Walgreens store on East Fifth Avenue.

Demand for the vaccine has grown steadily at Walgreens, too, Webbenhurst said. And that’s despite its high ticket price.

Depending on the pharmacy, the vaccine costs about $200 to $250. Most insurers cover at least part of the cost, although some may only cover it for those 60 and older. The vaccine is also covered by Medicare Part D, the drug plan.

Many pharmacies have agreements in place with local doctors that let them give the vaccine to anyone over 60 without a prescription. People ages 50 to 59 need a prescription.

A study published in April in the Journal of Internal Medicine found the vaccine was safe and had very few side effects. Researchers followed the medical records of nearly 200,000 people 50 and older after they got the vaccine.

They found no increased risk for stroke, heart disease or heart attack, meningitis or other serious complications.

The most common side effects are swelling and redness at the injection site, Webbenhurst said.

In declining to recommend the vaccine for those 50 to 59, the CDC also cited a history of production shortfalls. But Merck says the shortfalls, which started in 2007, were caused by shipping delays and problems getting enough raw materials to make the vaccine. It cleared its back orders in December and is now meeting demand, it says.

Because the Spokane Regional Health District follows CDC recommendations, it offers Zostavax only for people 60 and older, said Cindy Jobb, manager of the district’s public health clinic.

“It certainly is acceptable to (give the vaccine) according to the FDA, but that’s not how our policy is set up,” Jobb said.

Jobb said the clinic refers younger people seeking the vaccine to local pharmacies.


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