Antidote

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Last fall, the Centers for Disease Control vaccine advisory panel voted to make the shingles vaccination (which had been approved by the FDA in May 2006) routine for the 50 million Americans over the age of 60. I think this is a very good idea, though I am among those practitioners who have been slow to give it to my patients.

Why am I slow if I endorse the vaccine? As a practitioner, I am traditionally slow to change, and I tend to be a cautious observer in the first year of a new drug or vaccine's existence, but now that Merck's safe Zostavax has been available for more than a year, I have begun to eagerly order my supply.

Of those who have never received the chicken pox (Varicella Zoster) vaccine, 90% have had chicken pox. This means ALL folks over 60, since the chicken pox vaccine is relatively new. One million people develop the reactivation infection from dormant chicken pox of shingles (herpes zoster) every year, and nearly half of these people are over 60. About 20% of people who have had chicken pox end up getting shingles. Since shingles is painful, and can develop an extremely painful and prolonged complication known as postherpetic neuralgia, it is well worth vaccinating against. A group of people (15%) develop a complication that may blind them, known as ophthalmic neuralgia. This is another reason to vaccinate, especially when you consider that the only common side effects of the vaccine itself appear to be itching and headache.

 The vaccine (which lasts for 4 years) not only prevents shingles, it also reduces the excruciating post herpetic neuralgia by more than 65%. The pool of insurers who are covering this vaccine is growing. This is very good news, as not everyone can afford the $145 price tag. Of course, the severe complications of shingles can be far more costly. Zostavax is clearly a case where fear of the disease itself should outweigh any irrational fear of the vaccine.

Marc Siegel, MD, is an internist and associate professor of medicine at New York University and the author of False Alarm: The Truth About the Epidemic of Fear

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