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 drugs.
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.
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 treatments.
Good Vaccine, Terrible Disease
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.