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March 26th, 2011

Zoster Vaccine for Age 50 and Up? A Resounding “Yea” Vote Here

I was getting off the elevator at the hospital the other day, and a cardiologist greeted me with the phrase every ID doctor in the world will instantly recognize:

Can I ask you a quick question?

It was actually a series of questions, and, as is often the case, it wasn’t so “quick”.  But I was happy to help.

Her sister — age 57, living in Virginia — had just been diagnosed with ophthalmic zoster, and was having a very rough time of it.  Lots of pain, swelling, and of even greater concern, corneal involvement with markedly reduced vision.

The problem, of course, is that there’s only so much that antiviral therapy can do once shingles is diagnosed.  Far better, of course, is to prevent it in the first place.

Then the next day the FDA approved the zoster vaccine for people aged 50-59, reducing the age threshold by 10 years.

The reasons for approval are plain enough.  Around 200,000 people this age get shingles each year in the United States, and the vaccine reduces the risk by 70%.  So it’s even more effective in this young patient population (and I chose that adjective intentionally, ahem) than in those for whom it was originally approved.

Let’s hope the distribution and cost issues — which are substantial — are resolved soon, as this is one adult vaccine I most heartily endorse.

19 Responses to “Zoster Vaccine for Age 50 and Up? A Resounding “Yea” Vote Here”

  1. anonydoc says:

    Dear Dr Sax,

    So what was the question(s) you were asked by her?

    regards.

  2. Paul Sax says:

    Dear Anonydoc,

    The usual stuff — anything further that can be done, IV vs oral treatment, use of steroids, risk of bacterial superinfection and how can you tell when that (bacterial superinfection) happens.

    In short, the kind of questions for which there are unfortunately no clear answers, and which highlight that treatment of established severe zoster is only marginally effective.

    Paul

  3. Dr Robert McWilliam says:

    Zoster vaccine for the over 50s sounds a good idea to me.

  4. Robert M Wein, MD says:

    Have two on back order for three months for myself and my wife–ages 63/64.

  5. Rebeca Plank says:

    Dear Dr. Sax,

    In the case of a 50 year-old who denies any history of chickenpox, would you still recommend the zoster vaccine or would you check an antibody titer first?

    Sincerely,

    Rebeca Plank

  6. Unnie says:

    It would be great to know the number needed to treat to prevent one case of Shingles.

    Is HZV just as infectious when presenting with shingles compared with chicken pox.

  7. Robert Diez d'Aux says:

    Zoster vaccine for age 50 and up?

    Of course, it’s a no-brainer (except for the cost and supply issues).

    Add my resounding “Yea”.

  8. Philip Saccoccia Jr MD says:

    Maybe it’s opportunity for vaccine vendor to press TV advertising for something useful. Vendor should also offer two for one for everyone over 50. Loss leader works for erectile dysfuntion drug sales (the “free” first cialis script); it can work for vaccines too.

  9. Paul Sax says:

    Rebeca,
    Zoster vaccine guidelines say it’s ok to consider people born before 1980 immune … which pretty much covers everyone older than 50, if I did my math right!
    Paul

  10. nan bigelow says:

    5 yr ago had shingles and quickly treated with anti viral so mild short shingles ensued……would I benefit from zoster vaccine…..

  11. rita raymond CRNP says:

    i have so many patients in their mid fifties who request this vaccine and until now i have had to tell them it is not approved-they are worried because of friends who have had terrible zoster outbreaks and suffered with them-this is another tool to help us keep patients healthy

  12. Mark says:

    Dr. Sax,

    I have not seen clear recommendations regarding how long after a shingles episode a provider should wait before administering the shingles vaccine. I have those with recurrent shingles or those who had a particularly rough time and would like the vaccine to help prevent another bout. Any insight? Thank you.

  13. Paul Sax says:

    Hi All,

    Lots of great questions/comments. Some brief responses:

    1) yes ok to give zoster vaccine to someone who’s had shingles before; no clear guidelines on how long to wait, but wait at least until acute illness has completely resolved. 1-3 months sounds about right.
    2) shingles is MUCH less contagious than chicken pox
    3) zoster guidelines are here, and excellent:
    http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e0515a1.htm
    4) more zoster vacccine questions answered here:
    http://www.immunize.org/askexperts/experts_zos.asp

    Paul

  14. Susan Womeldorf, MD says:

    Considering the vaccine costs $200 a pop, what is the number needed to treat and absolute risk reduction? in both age groups…

    Thanks!

  15. Rob Slocum says:

    I’m not so sure. I had it approx 5 years ago. Bummer but I’m fine now. I’ve read some studies that have shown only 50% efficacy. I remember a NNT of 70 which equals about $17,000 to prevent one case of a largely self limited illness. But we aren’t trained in the US health system to consider cost effectiveness….probaby why we are approaching $8000 per capita expenditures.

  16. nan bigelow says:

    Soooo, 70% efficacy ,$200 per dose,…..I would certainly want to be sure vaccine was viable. Is vaccine always transported under the best of circumstances – viability guaranteed? Also had post surgical infection requiring 3 yr IV antibiotics resulting in neutropenia – requires GCSF q 2 wk. When is the most optimum time to receive vaccine…Post GCSF or @ low ANC?

  17. Janet says:

    Dear Dr Sax,
    Do you recommend a 50 year old who doesn’t think they’ve had chicken pox still get the vaccine?
    Thank you.
    Janet

  18. Paul Sax says:

    Janet,
    The zoster vaccine guidelines do not recommend checking VZV titers in people born before 1980, so if you have vaccine available, then ok to give it. Note that the guidelines haven’t yet added the 50-60 age group, but the vaccine is approved for use in this group and it certainly works.
    Paul

  19. Janice Homer RN says:

    I am an RN working in a NICU. I have had zoster of the face, eye, pharynx, and neck three times. I have been out of work 12 weeks this year. I hail the release of this vaccine. Unless you have had this virus you cannot understand the pain and altered lifestyle you will have during and after the attack. You cannot work , sleep, and pain pills do not take away the nerve pain. Long after the zoster rash is gone there is several weeks or months of intermittent pain. I am getting the vaccine ASAP

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Paul E. Sax, MD

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