Understanding the Shingles Vaccine
Experts talk to WebMD about a new vaccine that cuts the risk of shingles by 50%.
Who Needs the Vaccine?
While anyone can get shinglesshingles, it's most common in older people. Over
half of all cases are in people who are over 60. The older a person is, the
higher the risk of problems.
"About 40% of people 60 and older who get shingles go on to have lasting
nerve pain caused by PHN," says Gilden. "And that rises to almost 50% in people
70 or older."
The FDA approved the Zostavax vaccine for people who are 60 or older. Its
decision was based largely on the vaccine's impressive results in a study
published in the New England Journal of Medicine in June 2005. This
study tracked a group of 38,000 people over 60, with a median age of 69.
Researchers found that the vaccine cut the odds of getting shingles by 50%.
However, despite the FDA's decision, the vaccine still might be used by some
doctors in people under 60. This would be called an "off-label" use. Merck, the
vaccine's manufacturer, had hoped to get it approved for people 50 or older.
And Gilden says that people from age 50-59 are indeed at increased risk.
"People who are 50-59 account for one out of seven cases of shingles," he
tells WebMD. "That's a lot." But since the vaccine hasn't been studied in the
50-59 age group, FDA approval is unlikely any time soon, says Dworkin.
Another unanswered question is whether the vaccine is safe for younger
people at risk for shingles because of a weakened immune system. This would
include people who have had transplants, cancercancer treatments, or are living with HIV or other
"There are a lot of people looking at this question," says Dworkin. "I think
we'll start getting answers in the next three to five years."
Doubts About Widespread Use
As promising as the vaccine is, Dworkin points out that we don't really know
how many people will wind up getting it. Many things could get in the way.
First of all, a lot of people don't know much about shingles. It doesn't
have the fearful reputation of other illnesses. So it's unlikely that the
average person will be clamoring for the vaccine as soon as he or she hits 60,
"A lot of people have heard of shingles," says Gilden, "but they have no
idea how devastating an illness it can be."
Adults can also be tough to vaccinate, says Dworkin. While shots in
childhood are routine, adult vaccinations are harder to implement. Adults may
not see their doctor regularly. They may put off getting a shot. And while the
shingles vaccine could prevent hundreds of thousands of cases each year, an
average person might be unimpressed that Zostavax only prevents the disease 50%
of the time. People might expect a vaccine to protect them from a disease more
or less completely, not just reduce the odds to 50/50.
A great deal is resting on doctors and nurses to explain the benefits of the
vaccine and the risks of shingles. "But we all know the enormous time pressures
that are put on health care providers these days," says Dworkin. "Will they be
able to spare the 20 minutes to explain everything? We don't know."