Advances & Insights: General Health
What the news means for you
Kristy S. Deep, MD
Fewer chicken pox cases causes increase in shingles
Shingles is very common and can really affect someone’s quality of life. One in three people in the United States will get shingles at some point in his or her lifetime.
Over the last few years, there has been a slight increase in the number of people getting the disease and not just because people are living longer. Some scientists believe the increase is due to a lower incidence of chicken pox in children. As a result, adults are not being re-exposed and constantly boosting their immune system against shingles.
“Patients who got the vaccine had only half the number of cases of shingles; and if they got it, their disease was much milder.”
In the VA study, the patients who got the vaccine had only half the number of cases of shingles; and if they got it, their disease was much milder. They were much less likely to get the painful nerve condition that can follow an episode of shingles.
The vaccine was very effective the first year after it was administered. After that, immunity dropped slightly then seemed to hold steady over the next three years. For the next 10 years, 7,500 people in the study will be followed to see whether the vaccine will continue to prevent shingles.
We should be cautious about giving the shingles vaccine to people under 60 because we don't know how long it is effective. It is quite expensive, and to give it to a younger person at low risk for the disease may not be a wise use of health care dollars. Because of this, most insurance companies don't pay for vaccinating people under 60.
“The vaccine works by giving the immune system a taste of the varicella zoster virus so that when the immune cells see the virus, they ramp up their ability to fight it.”
Symptoms, treatment of shingles
We are not really sure exactly what triggers shingles to develop, but it is likely due to changes in cell-mediated immunity. The vaccine works by giving the immune system a taste of the varicella zoster virus so that when the immune cells see the virus, they ramp up their ability to fight it. This allows the immune system to do a better job keeping the virus in check as it lies dormant in the nervous system.
Patients often describe a burning pain or a sensation similar to pins and needles before the shingles rash appears. The rash is characterized by small fluid-filled blisters, or vesicles. What is most unique is that it will only affect the area of the body that one nerve root supplies. It differs from other rashes, such as poison ivy, in that it occurs in very different locations, and the burning or pain often starts before the rash appears sometimes up to a week in advance.
One patient of mine, a man in his 50s, had left-sided chest pain and thought he was having a heart attack. He was admitted to the hospital but found to have no signs of heart disease. He came to see me a few days later, still having pain. I checked beneath his shirt and he had just started to get the little blisters that are characteristic of shingles.
Shingles can be treated with an antiviral medicine, acyclovir. It is helpful in decreasing the pain and severity of the disease, but treatment must be started early to be effective. Anyone who develops this type of pain or a characteristic rash should see a health care provider at once. I also recommend the vaccine to all my patients over age 60.
Dr. Deep is an internist, director of the palliative care service and assistant professor of internal medicine in the UK College of Medicine.
Vaccine may help prevent shingles in people over 60
Millions of older Americans who suffered through chicken pox as children now find themselves at risk of a sometimes debilitating complication of the disease – herpes zoster, also known as shingles. This painful nerve inflammation, accompanied by a skin rash, is caused by the chicken pox virus, varicella zoster. The virus lies dormant in collections of nerve cells for decades after a bout of chicken pox and can be reactivated later in life as a person’s immunity dips, causing shingles.
“About 1 million people in the United States get shingles each year, and the risk goes up with advancing age.”
In May 2008, the Centers for Disease Control and Prevention (CDC) approved the first vaccine intended to reduce the risk of shingles in people 60 or older. The vaccine, called Zostavax™, is a version of the chicken pox vaccine, which was developed in 1995 for children. Only someone who has had a case of chicken pox or received the chicken pox vaccine can get shingles.
Because of the success of the chicken pox vaccine, there are fewer incidents today of what was once a common childhood disease. As a result, adults rarely get re-exposed to chicken pox. Re-exposure can help elevate antibodies to the varicella zoster virus.
Shingles is becoming more of a problem as people live longer. According to some estimates, about half of those who live to 85 will develop the disease. About 1 million people in the United States get shingles each year, and the risk goes up with advancing age.
The Shingles Prevention Study
Zostavax, which is made by Merck, was licensed in 2006 for use in people over 60 following a large-scale study of 40,000 patients sponsored by the Department of Veterans Affairs. In the randomized, placebo-controlled, double-blind study, researchers at 22 sites administered the vaccine or a placebo to adults 60 and over.
They found that the vaccine lowered the incidence of shingles by 51 percent and reduced cases of post-herpetic neuralgia - a painful condition that can persist long after a shingles attack - by 67 percent. The vaccine was more effective in people ages 60 to 69 than in older age groups.
The researchers estimated that the vaccine could prevent 250,000 cases of shingles a year and reduce the severity of complications in another 250,000.
Reported side effects include soreness and swelling at the shot site, as well as headache. No one knows yet what the delayed side effects of the vaccine might be, but the scientists are continuing to monitor the vaccine's usage.
Who should or should not get the vaccine
Merck is now seeking approval from the Food and Drug Administration (FDA) to give Zostavax to people as young as 50. About one in every seven cases of shingles occurs in this age group. However, research has not demonstrated the effectiveness of the vaccine in people younger than 60.
The vaccine is not recommended for a person who:
• has ever had a life-threatening allergic reaction to gelatin, the antibiotic neomycin or any other component of the shingles vaccine;.
• has a weakened immune system because of HIV/AIDS, treatment with steroids, or chemotherapy or a history of leukemia or lymphoma;
• has active, untreated tuberculosis;
• is pregnant or might become pregnant.
Health officials say as many as 35 to 40 million Americans are candidates for the shot, but few have gotten it so far. Cost is one prohibitive factor. Not all insurers pay for it, and cost for the patient can range from $165 to $300.
• Long-term proton pump inhibitor therapy and risk of hip fracture, JAMA, v. 296, no. 24, December 27, 2006, pp. 2947-2953
• Heartburn, American Gastroenterological Association
• Osteoporosis, American College of Rheumatology
UK HealthCare resources
• Digestive Diseases and Nutrition, UK HealthCare
• Orthopaedic Surgery and Sports Medicine, UK HealthCare
• Nephrology, Bone & Mineral Metabolism, UK HealthCare
Advances & Insights: General – Past Issues
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