Most people view chickenpox as a disease of childhood–or, as the vaccine against it is increasingly used, as a disease of the past. But varicella zoster, the herpes virus that causes chickenpox, is sneaky. Even after a varicella infection clears, the virus hides in the nerve cells, inactive. In about 20% of people who have had chickenpox, the virus will reappear later in life to cause shingles, a disease of severe pain and blisters on the body or face. Blisters on the face can cause problems with vision and hearing, while the spread of the disease to the body’s internal organs can cause serious damage, including encephalitis (inflammation in the brain).
A vaccine against shingles was approved by the U.S. Food and Drug Administration in 2006 after it was shown to be effective (in clinical trials, the vaccine reduced the risk of shingles by 50%). Recently, a long-term follow-up study of 38,000 participants from the trial that led to its approval also demonstrated its long-term safety. (The study, from the Annals of Internal Medicine, can be found here.)
The use of the vaccine, however, does not reflect the data on its safety or effectiveness: a separate study, also in the Annals of Internal Medicine, indicated that despite the vaccine being available since 2006 and recommended since 2008 by the Advisory Committee on Immunization Practices for all adults 60 or older, early use of the vaccine has been between only 2% and 7% in the United States. (That study can be found here.)
In the study paper, the researchers report that they surveyed approximately 600 internists and family medicine physicians in order to determine possible reasons for the low shingles vaccination rate. The most commonly cited reason for patients not receiving the vaccine was financial: it costs about $200. While that cost is reimbursed through Medicare Part D, only 45% of those responding were aware of this fact, which may have contributed to patients’ decisions not to take it. Other factors that may have contributed to the low use of the vaccine were weak recommendations from doctors (less than half of those surveyed said they strongly recommended the vaccine to their patients, while 90% strongly recommended pneumococcal and flu vaccines) and availability (less than half of those surveyed stocked the vaccine in their offices; most sent patients to a pharmacy to purchase it, or to purchase it and receive it at the pharmacy).
James G. Donahue, DVM, PhD, and Edward A. Belongia, MD wrote an editorial to accompany the two study articles, arguing that a wide approach is necessary to encourage adult vaccination. They argue that this is particularly important for shingles, as cases are likely to increase in the U.S. along with the increasing size of the elderly population as the baby boomer generation reaches retirement age.
For more information about shingles vaccination:
Safety of Herpes Zoster Vaccine in the Shingles Prevention Study
Annals of Internal Medicine, May 4, 2010. 152:545-554.
Link to article: http://www.annals.org/content/152/9/545.full
Barriers to the Use of Herpes Zoster Vaccine
Annals of Internal Medicine, May 4, 2010. 152:555-560.
Link to article: http://www.annals.org/content/152/9/555.full
The Looming Rash of Herpes Zoster and the Challenge of Adult Immunization
Annals of Internal Medicine, May 4, 2010. 152:609-611.
Link to excerpt: http://www.annals.org/content/152/9/609.extract