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A Review of Shingles Vaccine ZOSTAVAX

Worst Pills, Best Pills Newsletter article September, 2009

The shingles vaccine ZOSTAVAX reduces the risk of disease and serious complications from the varicella-zoster virus without serious side effects.

However, the effectiveness of the vaccine, which was approved by the Food and Drug Administration (FDA) in 2006, may decrease somewhat with age. That is to say, the older a person is when they receive the vaccine, the less likely it is to prevent shingles.

Shingles, or herpes zoster, is a painful rash (often accompanied by small blisters) that is...

The shingles vaccine ZOSTAVAX reduces the risk of disease and serious complications from the varicella-zoster virus without serious side effects.

However, the effectiveness of the vaccine, which was approved by the Food and Drug Administration (FDA) in 2006, may decrease somewhat with age. That is to say, the older a person is when they receive the vaccine, the less likely it is to prevent shingles.

Shingles, or herpes zoster, is a painful rash (often accompanied by small blisters) that is caused by the varicella-zoster virus. It typically affects the elderly or those with impaired immune systems.

The rash is usually limited to one part of the body but can occur anywhere, including around the eyes and ears, where it can cause blindness and deafness.

Some patients with shingles go on to develop severe chronic pain after the rash goes away – this is called post-herpetic neuralgia (nerve-derived pain).

ZOSTAVAX includes varicella-zoster virus that has been modified so that it can no longer cause active infection.

Study results

In 2005, a study published in The New England Journal of Medicine, in which nearly 40,000 patients over the age of 60 received either this vaccine or placebo injection, ZOSTAVAX reduced the overall risk of shingles by 51 percent and the risk of post-herpetic neuralgia by 67 percent.

The study also noted that the effectiveness of the vaccine may decrease with age. The rate of shingles decreased by 64 percent in people ages 60 to 69, by 41 percent in people ages 70 to 79, and by 18 percent in people over the age of 80.

In addition, the study found that even in people who received ZOSTAVAX but still developed shingles, the duration of pain was shorter than in people who received the placebo injection and developed shingles.

Although this study did not include patients who had previously experienced shingles, the Centers for Disease Control and Prevention recommends a single dose of the ZOSTAVAX for all adults over the age of 60, whether or not they have previously had shingles.

Side effects

ZOSTAVAX is given as a single injection under the skin, usually in the upper arm. According to the New England Journal of Medicine study, the rate of serious side effects from the vaccine is similar to the rate in patients who received a placebo injection.

The most common side effects were "injection site reactions," which include redness, swelling, pain and itching around the site of the injection. Injection site reactions occurred in 48 percent of people receiving the vaccine, compared to just 17 percent of people receiving placebo, according to the New England Journal of Medicine study.

About 1 percent of people getting the vaccine complained of a headache afterward.

Who should receive ZOSTAVAX?

People with a prior anaphylactic (severe allergic) reaction to the antibiotic neomycin, gelatin or any other component of ZOSTAVAX should not receive the vaccine.

Because ZOSTAVAX is a live vaccine, it should not be given to people with a weakened immune system.

This includes patients with:

• HIV infection
• untreated tuberculosis
• blood cancers (leukemia and lymphoma)
• patients on chronic immune suppressing medications (including steroids, radiation and chemotherapy used to treat cancers)
• patients who have any type of cancer that has spread to your bone marrow

Pregnant women should not be given the vaccine.

ZOSTAVAX has not been studied adequately in patients under age 60, so the vaccine should not be used in this age group.

The vaccine costs about $150. All Medicare Part D (Medicare prescription drug) plans cover ZOSTAVAX, but may require a copayment. Medicare Part B, which covers some vaccinations, does not cover ZOSTAVAX. Some private insurance plans cover ZOSTAVAX.

Did You Know?

The varicella-zoster virus is the same virus that causes chicken pox, a common childhood illness worldwide.

However, chicken pox has declined dramatically in the United States because of the widespread immunization of children and adolescents with the VARIVAX vaccine, which began more than a decade ago.

Both the VARIVAX and ZOSTAVAX vaccines contain the live inactivated virus, but the concentration of virus in ZOSTAVAX is much higher, so they are not interchangeable.