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Shingles vaccine is pricey, but could be a wise investment

Much as I enjoy keeping up with friends, cat videos and the wisdom of George Takei, I try not to spend too much time on Facebook. Depending on my mood, it can seem like everybody is having more fun than me, takes better pictures and makes superior restaurant choices.

But the other day, I saw a post that spoke to me. A high school friend announced that she shelled out $224 to get a shingles vaccination at her local supermarket. She noted that her health insurance would have covered her treatment had she actually come down with this painful adult consequence of childhood chicken pox, but given that she's much closer to age 50 than 60, the vaccine is not covered.

I responded that I also paid cash ($175 at the Pinellas County health department) for a shingles vaccine last December as a Christmas present to myself.

See what I mean about other people having more fun?

Anyway, Michelle and I got instant validation from Facebook Nation. One man posted about his permanent facial scars from shingles and pain that went on for months. A women wrote of her shingles misery ALL IN CAPITAL LETTERS for emphasis. Another man (Michelle's husband) described the pain this way: "Imagine not being able to stand the feeling of a shirt brushing against your skin!''

Others asked how effective the vaccine is, whether it prevents reoccurrences, whether you'll need a booster shot later if you get it before age 60.

"It's a no-brainer! Get the shot, folks!'' one commenter declared.

I wondered if it really is. So I called Dr. John Toney, an author of the landmark study on the shingles vaccine that came out a year before Zostavax was approved in 2006 by the FDA for most people older than 60. In 2011, approval was extended to ages 50-59, after a study of 22,000 showed it reduced the risk of getting shingles by 70 percent, compared to placebo.

Shingles — a reactivation of the same virus that causes chicken pox — can occur in younger adults, and even children. But most insurance only covers the vaccine after age 60, because that's when the risk escalates.

Toney didn't say I had wasted my money, but he didn't call my decision to get the vaccine at 52 a no-brainer, either. Unlike Facebook, scientists deal in evidence, not anecdotes.

"The big problem is not the rash and the pain. That will go away,'' said Toney, who is director of health care epidemiology at the James A. Haley VA Medical Center in Tampa, one of the sites where the vaccine was tested.

The real danger is post-herpetic neuralgia, or PHN, the phenomenally painful condition that can strike the most unfortunate shingles patients.

"In some people that can be extremely debilitating,'' he said. "Just clothing over an affected area can be intolerable. Just going outside feeling the breeze can be difficult.''

The risk of PHN also shoots up after age 60.

Zostavax isn't foolproof, but it certainly improves your odds. In studies involving nearly 40,000 older adults (including 1,200 Floridians), Zostavax reduced the risk of getting shingles by about half, and the risk of PHN by better than 60 percent.

Though the vaccine has been tested in the 50-plus set and shown to be safe and effective, the evidence isn't quite as compelling since shingles isn't as common at that age, said Toney, who also is a professor at the USF Morsani College of Medicine.

"I'm still not uncomfortable saying you get the biggest bang for your buck at 60. If you're interested at 50, fine, discuss it with your provider.''

But I didn't come away from our conversation feeling like I'd wasted my $175. I have more than that invested in shoes that hurt too much to wear.

Plus, as Toney said, "it's a whole lot cheaper to treat people when they don't get a disease than when they do.

"We've actually eradicated one disease (smallpox), not through antibiotics but through vaccine. And we're getting closer on polio. Vaccines are not perfect, but the risk/benefit ratio is absolutely one-sided.''

Whether or not you choose to get the shingles vaccine, Toney has this advice: At the first sign of trouble, like a tingly rash on your torso, get to the doctor for antiviral medication ASAP.

Not every rash is shingles, but if yours is, "the most important thing is to be seen within 72 hours,'' he said.

That's exactly what Toney did a few years ago at age 56 when he noticed what felt like a sunburn on his side.

"I got started on antivirals and it was gone in a day,'' the expert said of his own shingles experience. "I've never had another problem.''

But now that he is 60, he said, "I'm going to get the vaccine.''

Shingles vaccine is pricey, but could be a wise investment

05/17/14 [Last modified: Saturday, May 17, 2014 7:46am]
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