Anyone who's had chickenpox as a child — that's 99 percent of all adults — can wake up one day with a painful rash called shingles. It's caused by the chickenpox virus, which hides out in nerve cells for a lifetime.
A vaccine can help people over 60 avoid shingles, but only about 10 percent of the 50 million people who should get it actually have.
A vaccine can help people over 60 avoid shingles, but only about 10 percent of the 50 million people who should get it actually have. Pamela Moore/iStockphoto.com
A million Americans get shingles every year, and many are left with pain that lasts months and years after the distinctive red rash goes away.
That's what happened to a Massachusetts woman named Julie Fair. At first she and her doctor thought the pain was from a pulled muscle in her back. Then, three days later, an angry rash began to circle her midsection.
"It wrapped around as if a large hand were wrapping around my side," she says. Soon she was gripped by incredible pain.
"If the bedding at night moved over me, I would just scream," Fair says. "It was excruciating. Taking a shower was painful. It was really the most extreme pain I've ever had — more than childbirth because it was constant."
It didn't go away for six months. And even today — five years later — she feels a ghost of that pain on most days.
Avoiding The Disease
The good news is there's a pretty good vaccine that can prevent shingles, and it has been available for four years.
"This vaccine can prevent life-shattering disease," says Dr. Rafael Harpaz of the Centers for Disease Control and Prevention.
Harpaz and other researchers recently looked at how well the shingles vaccine worked in nearly 76,000 members of the Kaiser Permanente Health Plan in southern California who got the vaccine, versus a quarter-million who didn't. Their report is in the current issue of the Journal of the American Medical Association.
The bottom line: The vaccine prevents shingles 55 percent of the time. It's even better than that at preventing the most severe cases, such as Julie Fair's.
"This vaccine can prevent literally tens of thousands, or even hundreds of thousands, of shingles cases every year," Harpaz says.
Obstacles To The Vaccine
But the fact is only about 10 percent of the 50 million people who should get the vaccine actually have.
FDA via Wikimedia Commons
A diagram of the shingles virus.
"The recommendation is for everybody over the age of 60 to get a shot," says Dr. Richard Dupee, a geriatric specialist at Tufts Medical Center in Boston. The vaccine's maker, Merck and Co., has asked the Food and Drug Administration to lower eligibility to age 50.
Dupee says patients are slowly becoming aware there's a vaccine against shingles. But there are a bunch of obstacles to getting it into people's arms.
First, there have been repeated shortages. Merck says it can't make enough of the vaccine's main ingredient — a live but weakened chickenpox virus. Children's chickenpox vaccines have priority on the available supplies, says Dr. Eddy Bresnitz of Merck.
Dupee says he can't currently get Zostavax, the Merck vaccine. The company's website said the next shipments aren't expected until sometime this spring.
Then there's the cost. The vaccine is expensive — $160 a shot, plus an administration fee. For those over 65, Medicare covers it under its new Plan D, but reimbursement can be complicated. Most private health insurers cover it for patients between 60 and 65, but not all of them do.
Preston Hunt /Wikimedia Commons
The shingles rash is caused by the chickenpox virus.
The upshot of all this is that patients may have to put up the money in advance and get reimbursed.
Another problem is the vaccine needs to be kept frozen, and most doctors don't have freezers in their offices. So they send patients to drug stores.
"Most pharmacies don't have freezer space to handle the volume of Zostavax we would need," Dupee says. "So they order it, the patient picks it up, comes in here, and we give them the shot."
The shot, however, has to be given within 30 minutes after the vaccine leaves the freezer. If it thaws out, it's no good, and it's sometimes hard to manage the whole transaction from pharmacy to vaccination in a half hour.
Despite the obstacles, Dupee urges his patients to do whatever's necessary to get the shingles vaccine.
"If you've see a case — one case — of postherpetic neuralgia, you become a believer," he says. Postherpetic neuralgia is the medical term for shingles pain that lasts for months and years after the rash goes away.
An Uphill Battle
But Dupee says persuading patients to get the vaccine is an uphill battle.
"There really is a tremendous degree of resistance in this country" to many preventive treatments, he says. A patient's attitude often is, "I'm not going to get this disease, so I'm not worried about it."
A recent survey by the National Foundation for Infectious Diseases found that only half of Americans know there's a shingles vaccine, and just 16 percent know it's recommended for everybody over age 60. That includes people who have already suffered a bout of shingles, since it can recur.
Even when people are well aware of the risks and the need to be vaccinated, they don't always act on it. Dupee confesses he hasn't gotten around to getting vaccinated himself — but he promises to rectify that.