My wife and I, both retired senior citizens, were advised by our family physician to get immunized with the herpes zoster vaccine in addition to the flu and pneumococcal vaccines that we already have. Is the vaccine worth its price? —This email address is being protected from spambots. You need JavaScript enabled to view it.
At more than P5,000, Zostavax, the only herpes zoster vaccine currently available, is indeed rather expensive, but is it worth its price? I think this is a question which you yourself should answer, but I’ll help you decide by telling you what you need to know about the disease and its vaccine.
Herpes zoster or shingles (“kulebra,” in Filipino) is a peculiar disease. It is caused by the varicella-zoster virus (VZV), the same microorganism that causes chickenpox, but its manifestations are very different from the latter. Also, only people who previously had a natural infection with chickenpox or had been immunized with the chickenpox vaccine can develop the disease.
Primary infection with VZV results in chickenpox, which generally resolves spontaneously, but the virus does not perish, it simply hides in nervous tissues where it stays dormant for a long time. Presumably, this is also what the virus does when given in attenuated form as a vaccine. Years or decades later, the virus may break out and give rise, not to chickenpox, but to herpes zoster. Exactly how VZV remains latent, subsequently re-activate, and cause another disease is not understood.
Shingles can occur in young people, but a person’s risk for the disease and its complications increases with age. Statistics show that one out of every three people 60 years old or older will get shingles. Of these, one out of six will experience PHN.
Most people have only one episode of herpes zoster in their lifetime. Second and even third episodes, however, are possible.
Shingles is a painful ailment
Shingles is characterized by painful skin blisters or rashes that usually develop in a limited area on one side of the body, extremities, or face. The skin lesions are typically preceded by one to two days of pain over the involved skin area. The pain persists and often intensifies after the skin lesions appear.
The virus also affects the nerves that supply the area of the skin where the lesions are located. Thus, if the skin lesions are around the anal or bladder area, the patient may experience bladder and bowel problems. Likewise, it is not unusual for the patient to experience diminished sensation on the affected skin area or paralysis of the muscles that are supplied by the involved nerve. Also, lesions around the eye may cause impairment of vision.
The signs and symptoms of shingles generally subside within two to four weeks, but some people experience residual nerve pain, which can be very severe and debilitating, for months or years, a condition called postherpetic neuralgia (PHN). Rarely, the sensory loss, paralysis, and visual problems become permanent, too.
Shingles may have other long term complications
South Korean researchers who recently examined a database of 519,880 patients have noted another possible long-term health risk of shingles. They found out that people who had shingles had an overall 41 percent higher risk of cardiovascular events, such as heart attack or stroke, when compared to an age-matched control group that did not develop shingles. The risk of stroke was 35 percent higher and heart attack 59 percent higher.
The management of herpes zoster is difficult and expensive
There is no cure for herpes zoster. A variety of analgesics, to relieve the pain, are the main drugs prescribed by physicians. There are several antiviral agents—acyclovir, famciclovir, and valacyclovir—that can reduce the pain and shorten the duration of herpes zoster, but they are effective only if given early in the disease. For PHN, anti-depressants such as amitriptyline, anticonvulsants like gabapentin, and opioids such as codeine are used, but results are inconsistent. Overall, the treatment of herpes shingles and its complications is decidedly more expensive than the vaccine.
Does the herpes zoster vaccine offer full protection?
Zostavax, the herpes zoster vaccine, which is recommended for people aged 60 years and older and administered as a single shot, is not 100 percent effective. It merely reduces the risk of developing shingles by only 51 percent and PHN by 67 percent. Also, its efficacy wanes within the first five years after vaccination, and protection beyond five years is uncertain.
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Source: Manila Bulletin: Published
http://lifestyle.mb.com.ph/2017/07/25/is-the-zoster-vaccine-worth-its-price/
