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Senior Citizen Health & Medicine
FDA Says Senior Citizens Should Get Shingles Vaccine
but Many Docs Not Buying It
Mayo Clinic study finds two issues – cost and
perception that shingles primarily affects just those with weakened
immune systems
 Dec.
18, 2007 - When a vaccine to prevent shingles was approved for use in
2006, the Food and Drug Administration recommended the vaccine for
people age 60 and older who previously had chickenpox. But two issues -
the vaccine's cost and the perception that shingles primarily affects
adults with weakened immune systems - have left some physicians
undecided about whether healthy adults need the vaccine.
This
uncertainty prompted a group of researchers led by Barbara Yawn, M.D.,
of Olmsted Medical Center in Rochester, to gather new data about the
incidence and impact of shingles in unvaccinated patients.
Published in the November issue of Mayo Clinic
Proceedings, Dr. Yawn's research findings suggest that shingles and the
complications associated with it may have a greater impact upon healthy
adults than most physicians previously assumed.
"The best way to make a decision about who we
should vaccinate is by gaining a better understanding about the true
impact of this virus," notes Dr. Yawn.
"Physicians have access to very few recent studies
that tell us how many people in the United States get shingles, what age
groups the virus affects most, and how many of these people go on to
develop related complications or other problems."
 Study rationale and findings
Shingles isn't a life-threatening condition, but it can cause a painful
rash or band of blisters during an outbreak and other painful
complications that can persist for months or even years.
The goal of this study was to establish accurate,
up-to-date data about the incidence and impact of shingles in the United
States before the vaccine was introduced. Dr. Yawn and her team recorded
the number of adult residents of Olmsted County, Minn., who were
diagnosed with shingles and shingles-related complications from Jan. 1,
1996, to Dec. 31, 2001. Over the course of the study, 1,669 patients
were included.
Shingles more common in ages 50 to 59
Researchers calculated that shingles affects at
least 1 in every 278 adults in the United States each year. Study data
also showed that shingles is even more common among people ages 50 to
59, affecting about one in every 24 people each year.
"Overall, our data suggests that researchers and
physicians also need to consider preventing shingles in people ages 50
to 59," says Dr. Yawn.
"Future research is needed to understand the risk
of recurrence of shingles to better advise people who previously had
shingles about the value of receiving the shingles vaccine."
Weakened immune systems as targets
Dr. Yawn noted that study data also challenged the
assumption that shingles primarily affects adults with weakened immune
systems.
"More than 92 percent of the study subjects with
shingles did not have any conditions like cancer or other serious
illnesses that affected their immune system," says Dr. Yawn.
Post-herpetic neuralgia was the most common
complication noted, occurring in about 8 percent of all people and
increasing with age. This sometimes debilitating complication causes the
skin to remain painful and sensitive to touch for months or even years
after the rash clears up.
"About 18 percent of people age 80 or older
experience pain that lasts more than 90 days beyond the shingles,"
explains Dr. Yawn.
About shingles
Also known as herpes zoster, shingles is an infection caused by the
varicella-zoster virus, the same virus that causes chickenpox. Anyone
who has had chickenpox can develop shingles because some of the virus
lies inactive in the nerves and can reactivate as shingles.
Shingles is associated with a painful rash or band
of blisters that affects a limited area of the body, most commonly the
trunk, wrapping from the middle of the back and around one side of the
chest to the breastbone.
Alternatively, the painful rash may affect the
face, scalp or neck or occasionally an arm or leg. Complications that
affect about one in every five people with shingles include infection of
the eye and damage to the nerve to the eye, which can result in
decreased vision. In rare cases, shingles can also cause temporary
muscle weakness or paralysis on the side of the face affected by the
virus.
The shingles vaccine (Zostavax) can prevent
shingles in about 61 percent of those vaccinated. In vaccinated
people who develop shingles, the vaccine typically reduces the severity
of the outbreak and the risk for developing post-herpetic neuralgia.
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More
About Shingles |
Also called: Herpes zoster, Postherpetic
neuralgia
Shingles is a disease caused
by the varicella-zoster virus - the same virus that
causes
chickenpox. After you have chickenpox, the virus
stays in your body. It may not cause problems for
many years. As you get older, the virus may reappear
as shingles. Unlike chickenpox, you can't catch
shingles from someone who has it.
Early signs of shingles
include burning or shooting pain and tingling or
itching, usually on one side of the body or face.
The pain can be mild to severe. Blisters then form
and last from one to 14 days. If shingles appears on
your face, it may affect your vision or hearing. The
pain of shingles may last for weeks, months or even
years after the blisters have healed.
There is no cure for
shingles. Early treatment with medicines that fight
the virus may help. These medicines may also help
prevent lingering pain. A vaccine may prevent
shingles or lessen its effects. The vaccine is for
people 60 or over who have had chickenpox but who
have not had shingles.
National Institute of
Allergy and Infectious Diseases
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Editor's Notes:
A peer-review journal, Mayo Clinic Proceedings
publishes original articles, reviews and editorials dealing with
clinical and laboratory medicine, clinical research, basic science
research and clinical epidemiology. Mayo Clinic Proceedings is published
monthly by Mayo Foundation for Medical Education and Research as part of
its commitment to the medical education of physicians. The journal has
been published for more than 80 years and has a circulation of 130,000
nationally and internationally. Articles are available online at
www.mayoclinicproceedings.com.
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