This podcast discusses older adults and shingles, as well as the importance of getting the shingles vaccine. It is primarily targeted to public health and aging services professionals. Created: 9/24/2008 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) and National Center for Immunization and Respiratory Diseases (NCIRD).
Date Released: 9/24/2008. Series Name: Healthy Aging.
This podcast is presented by the Centers for Disease Control and Prevention. CDC – safer, healthier people.
The CDC urges people age 60 and over to get an important vaccine against shingles, which is also called herpes zoster. Shingles is a painful, localized skin rash that can occur in anyone who has ever had chickenpox — which is more than 95 percent of the adults in the United States. After a person has had chickenpox, the virus remains inactive in their nervous system. Later in life, the virus can become active again, travel along a nerve, and cause the rash and pain of shingles. There are about a million new cases of shingles each year in the United States. About one-third of the U.S. population will get shingles at some point in their lives. The risk rises after 50 years of age, and the highest risk is among people 60 years old and older. Half of people living to age 85 have had or will get shingles.
Fortunately, there is a new vaccine — called Zostavax — that can lower the risk of getting shingles. The U.S. Food and Drug Administration has licensed Zostavax as a one-time injectable vaccine for people age 60 and older.
When a person develops shingles, a rash appears on one side of the body, following the path of the affected nerve. The skin becomes red, blistered, and painful. Clusters of small bumps become fluid-filled blisters, which later drain and form crusted scabs. The weight of clothing or a passing breeze can cause agony for someone with shingles. Even sitting, sleeping, and eating are aggravating if those activities put pressure on the sores. Anti-viral medications can reduce the severity and duration of shingles, but they do not prevent the development of certain complications of shingles. The rash may continue for two to four weeks, but it eventually improves and the pain diminishes. However, somewhere between one-third and one-half of older adults with shingles can develop other complications, and the percentage rises with the age of the person in whom shingles develops. The most frequent complication is a chronic pain syndrome called postherpetic neuralgia. Postherpetic neuralgia can last months or even years after the blisters heal. Studies of pain severity have shown that the pain of postherpetic neuralgia exceeds that of pain associated with childbirth, musculoskeletal pain, osteoarthritis, or chronic cancer pain. In addition to the excruciating pain of postherpetic neuralgia, other complications of shingles may include scarring, secondary bacterial infections, pneumonia, visual and hearing impairments, and rarely, death. If left untreated, 10 percent of patients whose shingles affects an eye will experience severe visual loss, eyelid scarring, or chronic in-turning of the eyelashes.
Research has shown that shingles and postherpetic neuralgia can be as disruptive of a person’s quality of life as having congestive heart failure, diabetes, or depression. These findings underscore the importance of a vaccine to prevent shingles. Research clearly shows that adults age 60 or older can significantly benefit from the Zostavax vaccine. A large clinical trial — called the Shingles Prevention Study — compared Zostavax to a placebo in a study involving 38,000 adults who were age 60 years or older. The study found that the vaccine reduced the overall incidence of shingles in older adults by about 51 percent and reduced the incidence of postherpetic neuralgia by 67 percent. Considering how severely shingles can impact people and the vaccine’s reduction of the risk of developing postherpetic neuralgia, this is considered an important vaccine for older adults.
Experts recommend that the vaccine be given at the youngest eligible ages, that is, between ages 60 and 69, because it is more effective in that age group than in older age groups. But people 70 and older who have not been vaccinated against shingles can benefit from the vaccine as well. Nor should the oldest seniors be ignored. According to Dr. Rafael Harpaz, an epidemiologist with CDC’s National Center for Immunization and Respiratory Diseases, it is these older adults who are most likely to suffer detrimental effects from shingles and postherpetic neuralgia. They also have a harder time seeking and obtaining medical care to obtain anti-viral or pain medication to treat their shingles. Furthermore, these older adults tend to be more frail than people who are under 80 years of age, as they may have several chronic conditions. Also, according to Dr. Harpaz, “They are least able to tolerate postherpetic neuralgia and the powerful medications used to treat the pain of postherpetic neuralgia. People of this age have little reserve and are least able to handle the debilitating effects of shingles and postherpetic neuralgia.”
Most older adults, even those who are frail or taking multiple medications for chronic illnesses, should get the Zostavax vaccine. The only individuals who should not receive the vaccine are those on immunosuppressant agents, such as high-dose prednisone or cancer chemotherapy, and those with immunodeficiencies due to AIDS, leukemia, lymphoma, or certain types of tumors affecting the bone marrow or lymphatic system. The vaccine also is not recommended for women who are pregnant.
As with most vaccines, common side effects include mild reactions, such as discomfort, swelling, or redness at the injection site, headache, or itching. According to the CDC, no serious problems have been identified from the shingles vaccine.
Medicare Part D prescription drug plans cover Zostavax; however, beneficiaries may still have to pay a deductible or copayment for the vaccine. For those adults not yet old enough to receive Medicare, some state Medicaid programs will cover the vaccine for low-income people who are ages 60 to 64.
CDC is working hard to educate health professionals and the public about the importance of the Zostavax vaccine. CDC’s National Center for Immunization and Respiratory Diseases has developed fact sheets, posters, and a list of questions and answers that are available on its Vaccines and Immunizations website.
Older adults need to understand the serious nature of shingles and their risk for developing it. Several recent surveys found that many older adults do not know much about shingles and do not think they can get it. CDC is partnering with the Immunization Action Coalition, which works to increase immunization rates through public education.