Worst Pills, Best Pills

An expert, independent second opinion on more than 1,800 prescription drugs, over-the-counter medications, and supplements

Update on Herpes Zoster (Shingles) Vaccine: Zoster Vaccine Live (ZOSTAVAX)

Worst Pills, Best Pills Newsletter article April, 2011

What is Herpes Zoster (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 —...

What is Herpes Zoster (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).

Overview from the Centers for Disease Control and Prevention:

Almost 1 out of every 3 people in the United States will develop shingles, also known as zoster or herpes zoster. There are an estimated 1 million cases each year in this country. Anyone who has recovered from chicken pox may develop shingles; even children can get shingles. However, the risk of disease increases as a person gets older. About half of all shingles cases occur among men and women 60 years old or older.

People who have medical conditions that keep their immune systems from working properly, such as certain cancers, including leukemia and lymphoma, and human immunodeficiency virus (HIV), and people who receive immunosuppressive drugs, such as steroids and drugs given after organ transplantation are also at greater risk of getting shingles.

People who develop shingles typically have only one episode in their lifetime. In rare cases, however, a person can have a second or even a third episode.

Cause:

Shingles is caused by the varicella zoster virus, the same virus that causes chicken pox. After a person recovers from chicken pox, the virus stays in the body in a dormant (inactive) state. For reasons that are not fully known, the virus can reactivate years later, causing shingles. Herpes zoster is not caused by the same virus that causes genital herpes, a sexually transmitted disease.

The shingles vaccine zoster vaccine live (ZOSTAVAX) reduces the risk of contracting the rash by 55 percent in patients age 60 and older, according to a recent Kaiser Permanente study.

The study also reported that there was no evidence of diminishing effectiveness with older age.

In the September 2009 issue of Worst Pills, Best Pills News, we discussed the effectiveness of the vaccine in preventing and attenuating the severity of shingles (also known as herpes zoster) infections.

The results we reported were from the pre-approval studies that provided evidence that the herpes zoster vaccine works in a select study population under idealized circumstances. In contrast, the Kaiser Permanente study evaluated the vaccine in more typical field conditions, using adults age 60 or older in general practice settings.

The newer, real-world evaluation has yielded results even more favorable than those in the pre-approval clinical trial, which is especially noticeable when looking at the relationship between age and effectiveness. The study was considerably larger (almost four times as many patients were given the vaccine) than the earlier, pre-approval study.

In the first study, as we previously reported, the drug was most effective in those who were ages 60 to 69, in which group the vaccine reduced the risk of shingles by 64 percent. In the group with participants ages 70 to 79, the risk was reduced by 41 percent, and in those over age 80, the risk of shingles was reduced by only 18 percent.

But the Kaiser Permanente study found that those ages 60 to 69, 70 to 79 and over age 80 all had an approximately 55 percent reduction in contracting shingles.

In addition, the study found that the vaccine was associated with reduced risks of ophthalmic herpes zoster (a 63 percent risk reduction), a condition that can be accompanied by vision impairment. There also was a 65 percent reduction in hospitalization potentially attributable to herpes zoster.

Who should avoid ZOSTAVAX?

People with prior severe allergic reactions 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;
  • patients with untreated tuberculosis;
  • patients with 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 the bone marrow.

Pregnant women should not be given the vaccine. ZOSTAVAX also 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.