by Charles John Palenik, MS, PhD, MBA
For more on this topic, go to www.dentaleconomics.com and search using the following key words: vaccinations, shingles, chicken pox, Zostavax, Merck, injection, allergic reaction, infection.
When discussing vaccinations, we usually think of infants and young children. This is because diseases such as measles, mumps, influenza, varicella, polio, rubella, and pertussis can strike children younger than two years of age. However, not all vaccines are for young people.
In the United States, there are 27 vaccine-preventable diseases. Some adults incorrectly assume that the vaccines they received as children will protect them for the rest of their lives. Usually, this is true, except that:
- some adults were never vaccinated as children
- newer vaccines were not available when some adults were children (hepatitis A and B)
- immunity can begin to fade over time (tetanus)
- as we age, we become more susceptible to serious disease caused by common infections (influenza and pneumococcus).
There is a new vaccine designed for people age 60 and older. The varicella-zoster virus causes primary infections called chicken pox and recurrent infections called herpes zoster or shingles. Anyone who has had chicken pox can get shingles. This means approximately 96% of the adult population is at risk.
There are about one million cases of shingles annually in the United States. About one-third of Americans will get shingles. The risk increases after age 50. Half of the people living to age 85 have had or will get shingles.
Older Americans do not appreciate the seriousness of shingles. More than one-third of cases develop serious complications. The risk of complications increases after age 60. Prompt treatment is essential to control acute symptoms. Fortunately, a vaccine is now available that can decrease the chances of developing shingles.
On May 25, 2006, the U.S. Food and Drug Administration licensed Zostavax (Oka/Merck) to reduce the risk for herpes zoster, primarily for persons age 60 or older. Zostavax is a live (attenuated) vaccine, which enhances immunity. People age 60 and older, regardless of whether they report a prior episode of herpes zoster, can be vaccinated. Zostavax involves a single dose by injection under the skin, preferably in the upper arm.
Vaccines, like any medicine, possibly could cause serious problems such as severe allergic reactions. There have been no serious problems associated with the shingles vaccine. Mild problems include redness, soreness, swelling, or itching at the site of the injection (about one person in three) or headache (about one person in 70). The shingles vaccine continues to undergo close monitoring for unusual or severe problems.
Some people should not get shingles vaccine or should wait. Persons who should not get shingles vaccine include those who:
- have ever had a life-threatening allergic reaction to gelatin, the antibiotic neomycin, or any other component of shingles vaccine; tell your physician if you have severe allergies
- have a weakened immune system because of HIV/AIDS or another disease that affects the immune system
- have been treated with drugs that affect the immune system, such as steroids
- have had cancer treatment, such as radiation or chemotherapy
- have a history of cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma
- have active, untreated tuberculosis
- are pregnant, or might be pregnant.
Women should not become pregnant until at least three months after receiving the shingles vaccine. Some drugs, such as corticosteroids or immunosuppressants, may decrease Zostavax's effectiveness or increase risk of infection.
Someone with a minor illness, such as a cold, may receive the vaccine; however, anyone who is moderately or severely ill should usually wait until recovery before getting the vaccine. This includes anyone with a temperature of 101.3°F or higher.
In a clinical trial of adults age 60 or older, Zostavax prevented shingles in about half (51%) of the people and postherpetic neuralgia in 67% of the participants. While the vaccine was most effective among those age 60 to 69, it also provided some protection for older groups.
Dr. Charles John Palenik is the director of Infection Control Research and Services at the Indiana University School of Dentistry. In 2003, he was chairman of the Executive Board of OSAP, dentistry's resource for infection control and safety. Direct infection control questions to [email protected].
