Friday, May 16, 2008


CDC Urges Shingles Vaccine for Most Patients 60 and Older

By Michael Smith
ATLANTA, 16 may 2008 -- Nearly everyone 60 and older should be vaccinated against shingles with a single dose of zoster vaccine (Zostavax), the CDC said today.The advice for near-universal application of the so-far underused vaccine came after a unanimous recommendation in favor of this approach by the CDC's Advisory Committee on Immunization Practices.The late reactivation of the varicella virus causing shingles can affect anyone who has ever had chickenpox, which includes 95% of adult Americans. About a million cases of shingles are reported yearly in the U.S. Pain associated with the disease can be "life-altering," pointed out William Schaffner, M.D., of Vanderbilt University in Nashville, who was a liaison representative to the CDC advisory committee from the National Foundation for Infectious Diseases.
The vaccine could potentially be used by up to 43 million Americans, but only two million doses have been sold. "That's a huge gap," Dr. Schaffner said.
The condition usually causes a painful rash and blistering on the trunk, but can also affect the face and other areas of the body. It often leaves a legacy of continued pain caused by damage to nerves of the affected area.
If the disease affects the face, it can be disfiguring, he said, and in some cases affects vision.
"This is really a nasty illness," he said. "We are delighted that this vaccine is available to not only prevent the initial disease, but also the post-shingles pain."
Exceptions to the recommendation for vaccine use are those with a compromised immune system, whether from disease or therapy, and those with allergies to any of the components of the vaccine.
So, for instance, patients with leukemia, lymphomas, or HIV should not take the vaccine, or those allergic to such vaccine components as gelatin or neomycin.
Because the vaccine contains a live attenuated virus, it can cause disease in people whose immune systems are not fully active, the CDC said.
The CDC said a history of shingles is no barrier to subsequent vaccination, but recommended at least a two-year gap between disease and immunization.
The agency said the vaccine reduced the occurrence of shingles by about 50% in all patients 60 and older and did even better among those ages 60 through 69, a 64% reduction in cases.
The most common side effects in those who received Zostavax were redness, pain and tenderness, swelling at the injection site, itching, and headache.
The roughly $150 price of the vaccine may be a barrier for many patients, especially those without health insurance, he said.
Even those with health insurance may find they are required to pay some of the cost, he said. A spokesperson for Merck, the maker of the vaccine, said about 94% of private insurance plans offer at least some coverage.
For those 65 and over, Medicare offers coverage under Part D. But Dr. Schaffner said the vaccine should have been placed under Part B, like the influenza and pneumococcus vaccines, to cover the price fully and bypass the "inconvenient, cumbersome, and confusing" hoops of Part D.
Dr. Schaffner said clinicians may have been reluctant to prescribe the vaccine until the CDC's full recommendations were available. "Clinicians now have a secure source of information about the vaccine and recommendations for its use," he said.
Dr. Schaffner said he is not only a clinician concerned about preventing the disease, but was also one of the participants (with his wife) in the clinical trial that looked at the efficacy of the vaccine.
When the study was unblinded, he said, he and his wife "were delighted" to find they had been in the active arm of the placebo-controlled trial.
Dr. Schaffner said he had no financial conflicts with regard to the vaccine.

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