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U.S. Panel Backs Shingles Vaccine

People 60 and older would be inoculated against blistering skin disease

WEDNESDAY, Oct. 25, 2006 (HealthDay News) -- A U.S. government advisory panel has voted to recommend that adults 60 and older be given a newly approved vaccine against shingles, a painful skin disease.

The recommendation comes from the Advisory Committee on Immunization Practices (ACIP), part of the U.S. Centers for Disease Control and Prevention. Such recommendations are usually followed by federal health officials and influence whether or not a vaccination will be covered by insurance companies.

The vaccine, Zostavax, can protect as many as 50 percent of older adults from developing shingles. It is made by Merck & Co., and was approved by the U.S. Food and Drug Administration in May.

Shingles, a blistering skin rash, is caused by the varicella-zoster virus, the same virus that causes chickenpox. After someone has had chickenpox, the virus lies dormant in nerve tissue. As people get older, the virus can reappear in the form of shingles. Shingles affects about half a million American adults per year.

Most of the time, the eruption is confined to the skin, but it can also affect the eyes and cause blindness. Patients can also develop a chronic pain syndrome that can be difficult to treat.

The vaccine isn't designed to prevent new infections but rather to prevent the infection reemergence. And it's not intended as a treatment for people who have or have had shingles.

"Now we have a strong, absolute recommendation that this vaccine is recommended for every person 60 and over, so this notches it up beyond the usual 'doctor-and-patient should consider this,'" said Dr. William Schaffner, chairman of preventive medicine at Vanderbilt Medical School in Nashville, and the National Foundation for Infectious Diseases liaison to the ACIP. "In effect, the advisory committee has established a new standard of care. Every patient should be vaccinated. That's how important they think the problem is and how good they think the vaccine is."

Schaffner sits on a data safety monitoring board for Merck, but not for this product.

According to the Associated Press, FDA's approval of Zostavax stems largely from a study of more than 38,000 people, in which 19,000 got the vaccine and others received a placebo shot. People who got Zostavax developed shingles at only half the rate of those who got the fake vaccine, the study found.

"This vaccine is a good thing," said Dr. Robert Schwartz, professor and chairman of family medicine and community health at the University of Miami Miller School of Medicine. "The hope is not so much that it's going to prevent shingles from occurring, which it does, but the real critical issue is preventing post-herpetic neuralgia," a debilitating pain syndrome.

"I would even say people over 50 should get the vaccine," he added.

Schwartz has lectured on the vaccine for Merck, but money received went into a university department education fund.

"You can only get shingles when you've been exposed as a child to chicken pox," Schwartz explained. "The viral particles migrate from the skin to the dorsal nerve root ganglia outside the spinal column. It usually lays dormant, but because of stress or ill health or treatment with anti-cancer drugs, the viral particles migrate back out to the skin and cause a painful rash."

"It can cause months and sometimes years of pain," Schwartz added. "Not everyone will get post-herpetic neuralgia but if you can get a vaccine to prevent both things, the risk is minimal and the cost is not excessive, about $150 for a one-time dose."

The vaccine is not recommended for people whose immune systems are compromised, such as those with HIV/AIDS, or patients receiving immunosuppressant therapy.

More information

The U.S. National Institute of Allergy and Infectious Diseases can tell you more about shingles.

SOURCES: Robert Schwartz, M.D., professor and chairman, family medicine and community health, University of Miami Miller School of Medicine; William Schaffner, M.D., chairman, department of preventive medicine, Vanderbilt Medical School, Nashville; Oct. 25, 2006, Associated Press
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