One diagnosis that I never like to make is shingles. Shingles is a rash that is confined to a dermatome, an area of skin that is controlled by one nerve. The rash can be quite painful; in fact, sometimes the pain starts even before the characteristic rash can be seen. In some very unlucky patients, the pain lasts long after the rash has healed – post-herpetic neuralgia.
There is a vaccine to help prevent shingles, or at least lessen any outbreak. In a clinical trial involving thousands of adults 60 years old or older, Zostavax® reduced the risk of shingles by about half (51%) and the risk of post-herpetic neuralgia by 67%. While the vaccine was most effective in people 60-69 years old it also provided some protection for older groups. No serious problems have been identified with the vaccine.
This is a one-time immunization. Research suggests that the shingles vaccine is effective for at least six years, but may last much longer. Even if a patient has had shingles, Zostavax can help prevent future recurrence. Ongoing studies are being conducted to determine exactly how long the vaccine protects against shingles.
Almost anyone 60 years of age or older should get the shingles vaccine, regardless of whether they recall having had chickenpox or not. Studies show that more than 99% of Americans ages 40 and older have had chickenpox, even if they don’t remember getting the disease. Certain people, primarily those with impaired immune systems, should defer.
The FDA has recently widened the scope of approval to patients ages 50-59. In a statement, the FDA said that among the newly approved 50 to 59 age group, about 200,000 people contract shingles each year. According to Karen Midthun, MD, director of the FDA’s Center for Biologics Evaluation and Research, “The likelihood of shingles increases with age. The availability of Zostavax to a younger age group provides an additional opportunity to prevent this often painful and debilitating disease.”