Shingles Vaccine

February 22, 2006 Shingles Shingles (herpes zoster) is an illness caused by a reactivation of the chicken pox virus (varicella). When a person gets chicken pox, the virus remains in the body. Though the symptoms disappear, varicella lies dormant in the roots of the sensory nerves. Normally, the bodys immune system keeps the dormant chicken pox virus in check. But with advancing age, the immune system weakens. The virus can reactivate and multiply, damaging the sensory nerve cells. Patients may experience extreme sensitivity or pain, itching or burning - usually on one side of the body or face. In some cases, the pain may be misdiagnosed as a heart attack, pleurisy, appendicitis or migraine. Patients may also experience fever and tiredness or weakness. About 4 or 5 days later, clusters of blister-like lesions break out in the same area as the pain. The blisters fill with pus and crust over in 7 to 10 days. The scabs fall off 2 to 3 weeks later. In some cases, the lesions may leave scars. About 20 percent of Americans develop shingles. According to the National Institute of Allergy and Infectious Diseases, more than one million cases will develop this year. The condition is most common in people over 50. Although shingles cant be spread from person to person, it can cause chicken pox in those who never had the infection or the vaccine. The most common complication of shingles is postherpetic neuralgia (PHN), defined as pain that persists for more than 30 days after the appearance of the rash or healing. Its caused when the nerve root is damaged or scarred by the virus. The pain can be very severe and debilitating. Some patients cant even tolerate a slight touch, such as that produced by clothing or a breeze. PHN can cause sleep disturbances, weight loss and an inability to take part in daily activities. The Shingles Vaccine Study Not too long ago, chicken pox was a very common childhood illness. Almost all children were exposed to the virus and developed the symptoms. Thus, a good proportion of older adults are at risk for getting shingles. The Department of Veterans Affairs (VA), in collaboration with the National Institute of Allergy and Infectious Diseases (NIAID) and Merck and Co., Inc., recently completed a study of a potential vaccine for shingles. The new vaccine is a more potent version of the live varicella vaccine currently used to immunize children against the chickenpox virus. The study enrolled 38,546 healthy adults 60 and older. The study participants were randomized to receive either the experimental vaccine or a placebo. After about a three-year follow-up, the researchers found the incidence of shingles was reduced by 51.3 percent in those who received the vaccine. Incidence of PHN was reduced 66.5 percent. John Tooney, M.D., Associate Professor of Medicine in the Division of Infectious Diseases at University of South Florida (USF) and Director of Health Care Epidemiology at James A. Haley Veterans` Hospital in Tampa, was one of the studys authors. He says that those who received the vaccine and still got shingles ended up with milder symptoms. So at the very least, the vaccine appears to reduce the risk of developing PHN. The vaccine is still waiting for final approval from the FDA. If the vaccine is approved, experts say it could potentially prevent about 250,000 cases of shingles each year in the U.S. and significantly reduce the severity of illness in 250,000 patients. AUDIENCE INQUIRY For general information on shingles: Centers for Disease Control and Prevention, http://www.cdc.gov National Institute on Aging, http://www.niapublications.org/agepages/shingles.asp National Institute of Neurological Disorders and Stroke, http://www.ninds.nih.gov VZV Research Foundation, http://www.vzvfoundation.org BIBLIOGRAPHY Arvin, Ann, M.D., "Aging, Immunity, and the Varicella-Zoster Virus," New England Journal of Medicine, June 2, 2005, Vol. 352, No. 22, pp. 2266-2267. Bader, Mazen, M.D., and David McKinsey, M.D., "Viral Infections in the Elderly," Postgraduate Medicine, November 2005, Vol. 118, No. 5, pp. 45-54. Dubinsky, R., M.D., et al.., "Practice Parameter: Treatment of Postherpetic Neuralgia," Neurology, September 2004, Vol. 63, No. 2, Pt. 2, pp. 959-965. "Experimental Shingles Vaccine Proves Effective in Nationwide Study," FDA Consumer, July-August 2005, Vol. 39, No. 4, downloaded from website (http://www.fda.gov/fdac/405_toc.html), January 19, 2006. Gilden, Donald, M.D., "Varicella-Zoster Virus Vaccine," New England Journal of Medicine, June 2, 2005, Vol. 352, No. 22, pp. 2344-2346. Mounsey, Anne, M.D., et al., "Herpes Zoster and Postherpetic Neuralgia," American Family Physician, September 15, 2005, Vol. 72, No. 9, pp. 1075-1080. "NINDS Shingles Information Page," Bethesda: National Institute of Neurological Disorders and Stroke, downloaded from website (http://www.ninds.nih.gov), January 24, 2006. Oxman, M., M.D., et al., "A Vaccine to Prevent Herpes Zoster and Postherpetic Neuralgia in Older Adults," The New England Journal of Medicine, June 2, 2005, Vol. 2271-2284. "Shingles," Atlanta: Centers for Disease Control and Prevention, downloaded from website (http://www.cdc.gov), January 24, 2006. "Shingles," Bethesda: National Institute on Aging, downloaded from website (http://www.niapublications.org/agepages/shingles.asp), January 24, 2006. "Shingles and PHN," New York: VZV Research Foundation, downloaded from website (http://www.vzvfoundation.org), January 24, 2006. Weir, Erica, "Vaccination Boosts Adult Immunity to Varicella Zoster Virus," Canadian Medical Association Journal, August 2, 2005, Vol. 173, No. 3, p. 249. Research compiled and edited by Barbara J. Fister