Q: What Is Shingles and Who Is at Risk?

Ask Our Expert About the New Vaccine Against Shingles

About Our Expert

Luther V. Rhodes III, M.D., is the Chief of Infectious Diseases at Lehigh Valley Health Network.

• What is shingles?
• Who is at risk for shingles?
• I understand there is a new vaccine to prevent shingles.
• How was the new vaccine tested?
• Are there any side-effects?
• Should Zostavax be used in people who are under age 60?
• Who else should not be immunized with Zostavax?
• Should someone who has already had shingles use the vaccine so they won't get it again?
• How much does the vaccine cost?

Q: What is shingles?

A: Shingles is a viral infection of certain nerves, often on the face, chest or abdomen. The red-based, blistered rash affects one-half of the body. It is a painful eruption which varies from mild to severe. People over age 60 risk developing long-lasting, pain called post-herpetic neuralgia (PHN).

Q: Who is at risk for shingles?

A: The shingles virus has two names: varicella-zoster virus (VZV) and chickenpox. It can spread to susceptible contacts so we isolate those infected with VZV until the lesions crust over.

Q: I understand there is a new vaccine to prevent shingles.

A: The FDA approved a vaccine called Zostavax in late May, 2006. Physicians should have supplies from the drug company in July. It is delivered as a single injection.

Q: How was the new vaccine tested?

A: Zostavax is a live virus vaccine, essentially a very concentrated version of the chickenpox virus used in children. However, it is only indicated in non-pregnant and non-immunocompromised adults 60 years of age or older who have a history of chickenpox. The advantages of this vaccine are to lower the frequency of adults developing shingles, lessen the severity of an attack, and most importantly, reducing the chance of developing post-herpetic neuralgia.

Q: Are there any side-effects?

A: In the largest study that was conducted to look at safety, rates of serious adverse events were similar in people who received Zostavax (1.4 percent) and those who received the placebo (1.4 percent).

The following common side-effects were reported more often in people who received Zostavax when compared to those who received a placebo: redness, pain and tenderness, swelling at the site of injection of the vaccine, and headache.

Q: Should Zostavax be used in people who are under age 60?

A: At this time, there is not enough information from the studies to determine the risks and benefits of Zostavax in people younger than 60.

Q: Who else should not be immunized with Zostavax?

• People who are allergic to neomycin or any component of the vaccine.
• People who have a weakened immune system caused by treatments they are taking (such as radiation or corticosteroids) or conditions they may have (such as AIDS or cancer of the lymph, bone or blood). Zostavax is a live vaccine.
• Children. Please note that Zostavax is not a substitute for Varivax, the vaccine to prevent chicken pox.
• Women who are or may be pregnant. People in close contact with pregnant women who haven’t had chickenpox should talk to their health care provider to decide if using Zostavax is right for them.

Q: Should someone who has already had shingles use the vaccine so they won't get it again?

A: No. Zostavax has not been studied among people who have had shingles, and its effectiveness in preventing repeat episodes is unknown. In any case, most people who have had shingles are unlikely to suffer another episode.

Q: How much does the vaccine cost?

A: The manufacturer plans to sell the vaccine to physicians for about $175 per unit, but what you will pay for the shot depends on your health plan and your physician’s additional costs. The manufacturer claims it will offer free vaccine to certain low-income patients. You may want to ask your doctor about this. My suspicion is that the vaccine will rival pneumococcal and influenza vaccines as being indicated for, and hopefully paid for, by medicare and other insurers.

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