LITTLE ROCK — It’s been six years since the federal government approved the shingles vaccination, but the immunization for older adults is still not widely in use despite dropping prices and an increasing number of insurers that cover it, a state health official said.
“It’s still very expensive — probably the most expensive common vaccine in the U.S.,” Dr. Dirk Haselow with the Arkansas Department of Health said.
The vaccine costs providers $167 per dose, but more is charged because of the expensive coolers, handling and monitoring required to prove the vaccine is stored properly, said Haselow, medical director and section chief of the department’s communicable disease and immunization program.
Some pharmacies and doctors’ offices have begun advertising the shots, and there are television spots in which a man describes shingles pain as feeling like hot coals on his neck.
The U.S. Food and Drug Administration first licensed the shingles vaccine Zostavax, manufactured by Merck, on May 25, 2006. Two years later, the federal Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommended the vaccine for people 60 and older, according to the CDC’s June 2008 publication of these recommendations.
“It’s allowed to be given to adults as young as 50,” Haselow said. “It would be malpractice for a doctor to give it to you at any age younger than that.”
RASH AND PAIN
Shingles is the common name for herpes zoster, or simply zoster, a painful skin rash that often has blisters, according to the CDC. Zoster is related to the chickenpox virus and is a complicated disease that medical researchers still don’t fully understand.
The rash usually appears on one side of the body and lasts from two to four weeks.
Its primary symptom, pain, can be severe. Other symptoms include fever, headache, chills and upset stomach.
“Very rarely, a shingles infection can lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis) or death,” the CDC says on its fact sheet, a portable document file that can be downloaded at cdc. gov/vaccines/pubs/vis/downloads/vis-shingles.pdf.
About 10-30 percent of shingles patients experience postherpetic neuralgia, a severe pain that can continue long after the rash clears. The condition is the real reason to get the Zostavax vaccination, Haselow said.
“The initial lesion you get is painful, but by itself is usually not a big ordeal,” he said.
Pain from postherpetic neuralgia may last for months or years, he said.
“Half of patients describe it as excruciating. ... It can affect your quality of life,” he said.
One piece of advice that the Cleveland Clinic offers is to seek medical attention at the first sign of the rash.
“To mitigate pain, limit the duration of symptoms, and prevent complications, antiviral medications should be started within 72 hours of the first sign of shingles,” the nonprofit academic medical center counsels online.
A nurse with the Cleveland Clinic who helps answer patient calls on its public telephone line said Friday that she’s starting to receive calls about the shingles vaccine at (800) 801-2273.
“I’ve had a few callers asking about the vaccine, and the side effects, and who it should be given to,” said the nurse, Katie, who answered the hot line Friday, adding she is not allowed by clinic policy to give out her last name.
CHICKENPOX LINK
Only someone who has had the chickenpox — or rarely, someone who’s had the chickenpox vaccine — can get shingles, according to the CDC.
That’s because once the chickenpox rash clears, the varicella-zoster virus remains dormant in the body and can be triggered again years later, for reasons that aren’t fully understood, returning as herpes zoster.
Chickenpox, primarily a childhood disease, didn’t have a licensed vaccine until 1995. So shingles’ primary victims are people old enough to have missed this vaccine and experienced chickenpox’s rash of itchy, fluid-filled blisters.
Shingles is progressively more common in older adults, who also tend to get the worst cases, and in people with compromised immune systems, Haselow said, though younger adults can get it.
The shingles rash typically follows along the rib cage, along the neck and shoulder, or on the upper half of the face, sometimes including the eye, according to the CDC information sheet.
This is because the chickenpox virus goes dormant in the nerves, which follow certain pathways that aren’t always continuously connected.
“The nerves, when they come across your back, they follow the same sort of direction as your ribs,” Haselow said.
“Usually it will be one half of their face, or a band going across one-half of their trunk,” he said.
The virus is one among the family of viruses called herpes viruses — the same viruses that cause sexually transmitted diseases and cold sores, all of which tend to invade and stay in nerves, Haselow said.
STD and cold-sore flareups can be triggered by stress. “It’s not well understood if that’s the case with shingles,” he said.
VACCINATIONS
A person can’t spread their shingles to others, though uncommonly their uncovered lesions could transmit chickenpox to a person who has never had the chickenpox or the chickenpox vaccine, Haselow said.
“It’s a very safe vaccine,” Haselow said, with the most common side effect being pain at the injection site.
But like other adult vaccines, the efficacy is relatively low.
“This vaccine is about 50 percent effective in preventing zoster, with about a 67 percent reduction in postherpetic neuralgia,” Haselow said. “Those numbers aren’t as high as they are for childhood vaccines, which typically have numbers as high as 90 percent or greater.”
Haselow believes the Zostavax cost should eventually drop.
Spokesmen for two of the three largest insurance companies in the state, Christy Garrett with QualChoice Arkansas and Tracey Lempner with United Healthcare, said they cover the vaccines in Arkansas — with QualChoice further specifying its coverage is for those 60 and older.
Arkansas Blue Cross and Blue Shield did not respond to a telephone message seeking coverage information.
Nationally, according to the CDC, all Medicare Part D plans cover the shingles vaccine.
Arkansas’ Medicaid doesn’t cover the vaccine, said Amy Webb, spokesman for the state Department of Human Services.
The Health Department has never stocked the zoster vaccine, Haselow said, citing budget constraints. And the department doesn’t track the shots either, so it has no data on usage.
Most of the Health Department’s vaccination program focuses on children.
Research in Northwest Arkansas found the shots available in Walgreens drugstores, where one employee quoted a price of $219.99 out of pocket for a Zostavax shot, and said someone 50-59 could get it only with a doctor’s prescription.
A location finder for at least some providers of the shot can be found at zostavax. com/find-zostavax.html.
A pharmacist at Collier Drug Stores Inc. said the local group of stores has been carrying Zostavax for about 11/2 years.
Brenna Neumann, who was working in Collier’s Fayetteville store Friday afternoon, wouldn’t reveal the pharmacy’s out-of-pocket charge for the vaccine or the pharmacy’s choice of age protocols on how it’s administered, saying that was proprietary.
But she said she believes a trend in the pharmacy industry has made the shingles vaccine more accessible to patients despite the fact it’s still expensive.
“As far as private insurers, more and more insurance is covering it under the pharmacy benefit,” Neumann said.
It’s become a standard of practice for pharmacists to administer vaccines, she said.
Arkansas, Pages 11 on 06/06/2012