Oct. 25, 2006 - The CDC's vaccine advisory panel today voted to make
shingles vaccination routine for all Americans 60 and older.
Shingles is a painful disease caused by reactivation of dormant varicella
zoster virus, or VZV. Best known as the virus that causes chickenpoxchickenpox, VZV is a herpesherpes virus that can come back with a vengeance
when a person's immunity wanes with age, disease, or immunity-suppressing
Without vaccination, about 20% of people who have had chickenpox eventually
will get shingles. A person who lives to be 85 has a 50% chance of getting
Shingles is a bad enough disease to be a good reason to get vaccinated.
But in about a third of cases, shingles turns into an excruciatingly painful
disease called postherpetic neuralgia, or PHN. A smaller percentage will get a
painful, blinding disease called ophthalmic zoster.
The new vaccine, Merck's Zostavax, won FDA approval last May.
Now the main U.S. vaccine advisory panel -- the Advisory Committee on
Immunization Practices (ACIP) -- officially recommends routine use of the
vaccine for everyone 60 and older.
The committee voted not to make shingles vaccination routine for people
under 60, citing a lack of clinical data on vaccination in that age group.
Similarly, the panel said there was too little data for it to recommend that
doctors offer the vaccine for people about to undergo immunity-suppressing
A major clinical trial shows the vaccine is more than 60% effective in
reducing shingles symptoms. Perhaps most importantly, it reduces painful PHN by
at least two-thirds.
"Reducing PHN is the motivation for most of us working on this clinical
trial," Michael N. Oxman, MD, of the University of California, San Diego, said
in a presentation to the ACIP. "For people with severe PHN, their lives are
blighted and the lives of their families are blighted."
PHN pain can last for years. Sudden, lancing pain can quite literally bring
patients to their knees. Each year, there are more suicides due to PHN pain
than due to cancercancer pain.
And PHN isn't the only bad complication of shingles. Some 15% of shingles
patients get ophthalmic zoster -- shingles that affects one or both eyes.
In a public comment, Herbert Kauffman, MD, former chairman of ophthalmology
at Louisiana State University, offered the ACIP a graphic description: "This is
not going blind in peace and quiet," Kauffman told the ACIP. "This is an
all-consuming pain patients live with every moment of every day for years."
The ACIP recommendation means insurers will be more likely to pay for
shingles vaccination in 60-and-over patients.