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Considering the Shingles Vaccine?

A case of chicken pox was just reported at my children’s high school.  A 14-year old developing varicella (‘chicken pox”) in a school system that requires an up-to-date vaccination record before a child can enter school seems impossible.  But it’s not. Prior diagnosis of chicken pox and even a childhood vaccination are not guarantees of lifelong immunity. And here’s where a little education about chicken pox and its ugly-headed companion, shingles, can be useful.

Chicken pox and shingles are caused by the varicella-zoster virus, a herpes virus type 3.  A child infected by chicken pox, or vaccinated against it, develops an immunity that should protect against a second infection later in life.  The antibodies to the virus fight it whenever a person is exposed.  Chicken pox is an immediate response to the virus in a non-immune person.  Shingles is a reactivation of the virus that has been “latent” or hiding in a nerve ganglion for many years, often decades.

A decade ago my friend Max, then 45 years old, developed shingles, the eruption of extremely painful blisters. He had pain in his chest that extended up to his neck, and thought he was having a heart attack.  But the pain wasn’t angina; it was the reactivation of the varicella- zoster virus he had endured as a child.  Many of us born before the vaccine was available had the disease and then developed antibody immunity.  But even with the immunity, whether by vaccine or natural process, the virus can sit quietly in a single nerve ganglion and then return to that area of skin, or “dermatome,” often during times of extreme stress or illness. Shingles can spread to other areas and even affect internal organs when it attacks people with compromised immune systems.  Cancer patients on chemotherapy are vulnerable.

A victim of the life stressors that frequently hit us in our middle-aged years, Max was lucky that his case of shingles was diagnosed quickly. He was immediately put on medication to relieve the pain and truncate the course of the virus.

Now, 10 years later, we have some good strategies for preventing Shingles, yet like the varicella vaccine, they’re not perfect yet.

The new Shingles vaccine Shingrix is the recommended vaccine for those over 50 years of age.  Shingrix is a “dead” vaccine which is given in 2 doses 6 months apart.  It is 90% effective in preventing Shingles, and also contains an additional substance that helps the body fight the shingles in the unlikely event that it does occur. Shingrix is in very short supply right now because it is new and effective.

Zotavax is a live vaccine that is recommended for people over the age of 60, but is only 40% effective.  It is formulated from a ‘live” virus that is close to the actual virus but has been modified to cause your body to mount an immune response without causing symptoms.  Because Zostavax is less effective, the CDC recommends that those that have received Zostavax be reimmunized with Shingrix.

All those over 50 should get the Shingrix vaccine UNLESS THEY:

  • have an active case of shingles
  • have never had chicken pox AND have never received the varicella vaccine. Those people should get the varicella vaccine for primary immunity
  • are allergic to the suspension in which the virus is injected (ask your doctor)
  • are breastfeeding.

Currently, insurance companies reimburse for Zostavax.  However, some are requiring that to get the $280 Shingrix vaccine, you must pay out of pocket, and you may or may not be reimbursed later.

Think carefully before you decide that the cost is prohibitive, however. Shingles, though not life-threatening, can be among the most painful experiences you’ll ever endure.

If you still cannot afford the vaccine, get the Zostavax vaccine that is recommended by the CDC at the present time, and then be revaccinated with Shingrix vaccine when it becomes reimbursable, and more readily available, probably within 12 months.

– E.C.T.

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