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Shingles can lead to awful pain, but a vaccine that reduces risk is too expensive for many.
Published Jul. 8, 2010

Almost all American adults - 95 percent, according to the Centers for Disease Control and Prevention - are at risk for a painful outbreak of the infection known as shingles. A good proportion of shingles patients develop a complication that is considered downright agonizing and debilitating.

Yet few people have gotten the vaccine that can reduce your risk by well over half. The vaccine, known as Zostavax, was approved by the FDA in 2006; two years later, fewer than 7 percent of those eligible had received the vaccine. The CDC says coverage has increased some since then, but there is no new data available.

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If experience provides a clue, Zostavax use is probably not up by much, according to Dr. Ajoy Kumar, a primary care physician in St. Petersburg. Kumar, assistant director of the family medicine residency program at Bayfront Medical Center, says all his physicians offer every patient age 60 and older Zostavax, but few accept.

"Not many people are getting it, especially compared to the influenza vaccine. Funding is a significant issue," he says.

For good reason. Kumar says the cost to patients for the single-dose vaccine ranges from $165 to $300. Medicare treats it like a prescription drug. So while it is covered under Part D, the prescription drug coverage plan, many patients still must meet high deductibles, have high copays or, if they have reached the so-called doughnut hole in coverage, must pay the entire cost out of pocket.

"That's a whopping amount when you consider that a flu shot costs between $11 and $15," Kumar says.

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There are more than 1 million new cases of shingles every year in the United States. Anyone who has had chicken pox is at risk, but the older you get the more likely you will be affected.

More than one third of those who get shingles also will develop a serious postrash complication called postherpetic neuralgia, or PHN, one of the most painful chronic medical conditions that doctors treat today.

In past generations, nearly every kid came down with chicken pox: red spots, an itchy, blistering rash and fever. Some mothers even threw chicken pox parties. When one kid on the block got sick, all the neighborhood kids were invited over to get exposed and "get it over with."

Still, having chicken pox was nothing to celebrate. It used to send thousands to the hospital, and it killed 100 American children each year. But, once you had the disease you were considered immune.

Many children today are spared the disease due to the chicken pox vaccine, which has cut hospitalizations and deaths from varicella more than 90 percent since its introduction in 1995.

But whether you had the disease or the vaccine, you still have the remnants of the virus that causes chicken pox, the varicella-zoster virus from the herpes family. Usually it stays dormant. But for unknown reasons, in some people the virus surges back to life and appears as a blistering skin rash, usually on the face or torso.

It can range from mild to severe and can last for weeks or months. Antiviral medication administered within 72 hours of the onset of symptoms can help shorten the course of symptoms. Most patients eventually recover and return to normal activities.

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But about one-third of patients aren't so lucky. They develop PHNafter the rash heals - a type of chronic nerve pain that can last for years and is so severe that clothing, a slight touch, even a puff of air can cause unspeakable agony. Some of these patients never return to their normal life.

"This neuropathic pain is almost in a class by itself," says Dr. Margarita Nunez, a researcher and medical director of Comprehensive Clinical Research in St. Petersburg. Nunez has been involved in several clinical trials testing a novel pain reliever for PHN that received FDA approval last November and hit the market in April.

The Qutenza patch contains a topical medication made from a high-dose synthetic form of capsaicin, the substance that makes chili peppers hot. A one-hour treatment provides varying degrees of pain relief that lasts up to three months. Most importantly, it is non-narcotic and won't even cause drowsiness.

"It's not uncommon to see PHN patients addicted to narcotic medications because that's the only thing that gives them pain relief. This patch is one more option that they can try, that is safe and doesn't have to be taken every day," says Nunez.

But ask anyone who has had shingles or PHN and they will tell you: Prevention is really the best alternative. Zostavax is about 50 percent effective in preventing shingles and reduces the incidence of PHN by almost 70 percent. The vaccine is recommended for most Americans age 60 and older. The closer you are to 60 when you get the vaccine, the more effective it is at preventing an outbreak.

But health experts say it will still provide some protection when given after age 60 and may lessen symptoms in those who do get shingles. Kumar tells patients, "It's a great investment. I personally would definitely get it. I've seen postherpetic neuralgia, and it is horrendous."

Irene Maher can be reached at or (813) 226-3416.