Coping with Chronic Illness

Shingles Vaccine Shortage

A combination of factors has dissuaded many physicians’ offices and clinics from carrying Zostavax. And its manufacturer, Merck, has been unable to produce sufficient quantities to meet even modest demand.

• The vaccine is made with a live attenuated virus that has proved difficult to grow in bulk, and also is needed to make the childhood chickenpox vaccine.
• Zostavax is the most expensive adult vaccine, selling for about $160 a dose, not counting the cost of an office visit and injection. Few insurers will currently cover the cost for patients under age 60.
• Because the vaccine must be stored frozen and few doctors’ offices are equipped with freezers, many patients must turn to pharmacies for the shot.

Intermittent shortages that last months have kept the company from consistently marketing the vaccine and have forestalled public health campaigns that could have built awareness of the need for it.

From Drive to Stem Shingles Meets Few Expectations by Paula Span, NYT. Please read the entire article.

Shingles Vaccine

Zostavax, as the vaccine is called, was approved in 2006, based on the results of clinical trials. The U.S. Centers for Disease Control and Prevention recommends the shot for eligible people aged 60 and older.

Because shingles is not contagious and doesn't present a risk of death, [Dr. Bruce Hirsch, an attending physician in infectious diseases at North Shore University Hospital in Manhasset, N.Y.] said he would recommend the flu vaccine and the pneumococcal vaccine over this one for uninsured patients who would have to pay out-of-pocket.

"This study helps me in terms of advising patients and prioritizing," Hirsch added.

While less reliable than some childhood vaccines, which are usually 90 percent effective in preventing certain illnesses, the shingles vaccination is still worthwhile, said Dr. Ciro Sumaya, professor of health policy and management at Texas A&M Health Science Center School of Rural Public Health.

For now, he advises getting it. "It's protecting against a severe disease, particularly in elderly adults," he said, "so the benefit, I think, is overwhelming that we should be using this because it's recommended."

I think you all know where I stand on this vaccination. If you can possibly get it, do so. I think it should be covered by insurance companies, because the effects of shingles can be severe and disabling. It's accurate to say that shingles won't kill you while the flu or pneumonia could, but that ignores the possibility of long-term pain, or even blindness in the case of opthalmic herpes zoster. 

 Always consult your doctor before making any health decisions.

Check out my previous post on shingles and post-herpetic neuralgia here.

Why are ever-younger adults contracting shingles?

Here’s why: according to studies conducted in the 1960s by the British GP and epidemiologist Robert Edgar Hope-Simpson, those who are repeatedly exposed to chicken pox—health care workers, say, and families with young children—are less prone to a reactivation of the virus. Greater exposure actually lessens the risk of shingles. It follows, McGeer says, that the immune systems of young adults who didn’t get the varicella vaccine won’t have that extra boosting that would help prevent shingles—the younger, vaccinated generation won’t provide any exposure. So adults in their 20s and 30s have two strikes against them: they’ve had the virus, so it can be reactivated, and they haven’t had the exposure that would heighten their immunity. “They are going to have a problem,” concludes McGeer. [Source]

PHN treatment recommendations.

Click here to download:

pdf_5807_5807JFP_ClinInq5.pdf (134 KB)

(download)

Click here to download:

pdf_5807_5807JFP_ClinInq5.pdf (134 KB)

Vol 58, No 7 / July 2009 The Journal of Family Practice

Information brochure about PHN and its treatments.

Click here to download:

PHN_Brochure_Feb2004.pdf (1.56 MB)

(download)

Click here to download:

PHN_Brochure_Feb2004.pdf (1.56 MB)

Findings from a survey about shingles/PHN.

The American Pain Foundation (APF) announced today at the American Pain Society (APS) Annual Meeting the results of a national survey that showed postherpetic neuralgia (PHN), also known as after-shingles pain, continues to be a condition with low awareness amongst Americans, demonstrating a need for health care provider (HCP) intervention. ... The condition affects approximately 1 million people in the United States every year, and one in five of those who suffer may go on to develop PHN, which results from nerve damage caused by the shingles rash. For some, the PHN pain can become so severe that it significantly impacts quality of life. PHN is one of the most common causes of pain-related suicide in older Americans.

Key findings from the 414 people surveyed who have had shingles include:

A Lack of Education and Communication about PHN

• While nearly 60 percent of respondents said their physician mentioned  burning, aching, sharp or itching pain in relation to their shingles outbreak, only one-third reported being told by an HCP about the possibility of developing PHN
• Of the survey respondents who first experienced after-shingles pain, almost half (42 percent) did not think that it was related to their shingles rash in any way

The Prevalence of PHN

• Fifty-one percent of survey respondents reported experiencing pain, shortly after or within months, after their shingles rash went away
• Among respondents who experienced PHN, 16 percent reported that after-shingles pain lasted for 15 weeks or more
• More than half of respondents said the pain they experienced after having shingles was more frustrating than actually having shingles

Treatment Option Preferences

• More than 70 percent of respondents were interested in using a topical treatment, alone or in combination, to relieve after-shingles pain

[Source]

Shingles, Post-Herpetic Neuralgia, and Me!

I came down with shingles in March 2008. Shingles “is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a stripe. The initial infection with varicella zoster virus (VZV) causes the acute (short-lived) illness chickenpox, and generally occurs in children and young people. Once an episode of chickenpox has resolved, the virus is not eliminated from the body but can go on to cause shingles—an illness with very different symptoms—often many years after the initial infection.”

Lucky me, I got Post-Herpetic Neuralgia afterward. As my doctor put it my nerves are “freaking out.” “Postherpetic neuralgia is thought to be nerve damage caused by herpes zoster. The damage causes nerves in the affected dermatomic area of the skin to send abnormal electrical signals to the brain. These signals may convey excruciating pain, and may persist or recur for months or even years.”

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