Studies: Shingles Vaccine Safe, Underused

By Lori Wiviott Tishler, M.D.
Content provided by the Faculty of the Harvard Medical School

A vaccine to prevent shingles is safe, but not used often enough, new research concludes. One study followed up on people who were in the study that led to approval of the vaccine in 2006. That study included 38,546 adults, age 60 or older. The new study focused on 6,616 of them to take a closer look at side effects. Researchers kept track of them for 3.4 years. In this time, people who got the vaccine and those who got placebo shots were equally likely to have hospital care or die. Right after getting the shots, people who got the real vaccine were more likely to have a skin reaction at the site. A second study surveyed 600 doctors. About 88% urged patients over 60 to get the vaccine. But only half that many recommended it strongly. Many doctors cited financial barriers. The vaccine costs $200. Fewer than half of the doctors knew that Medicare Part D will pay for it. The studies were in the journal Annals of Internal Medicine. MedPage Today wrote about them May 3.

What Is the Doctor's Reaction?

Whenever I think about herpes zoster, or shingles, I am reminded of an elderly woman who was my patient many years ago. She was a dynamic, bright, interesting woman who developed shingles on the side of her right ear. Having shingles was terrible for her. It was painful and it was itchy. It took a long time to get better.

Even worse, she had pain after the shingles infection was gone. This pain is called post-herpetic neuralgia. It was awful for her and really interfered with her quality of life.

I was thrilled when a vaccine came out to prevent shingles in 2006. The vaccine decreases the risk for shingles by about half. It reduces the risk of post-herpetic neuralgia by two-thirds.

The journal Annals of Internal Medicine includes two new studies and an editorial about this vaccine. They bring out many important points.

First and foremost, the vaccine is safe. The Shingles Prevention Study was conducted at 22 sites, with almost 40,000 patients. Very few people reported problems from the vaccine. Soreness at the injection site was the most common. The risk of severe side effects was 1.4% in people who received either the vaccine or a placebo. Importantly, there was no increased risk for shingles in people who got the vaccine.

This study did not include very sick, elderly adults. It did not include people with weakened immune systems from HIV or cancer. But for healthy older adults, the vaccine seems both safe and effective. This is wonderful to know and good news for patients who were waiting to see about the new vaccine.

A companion article looked at barriers to doctors' use of the vaccine. The major barrier was the perceived cost. A second problem was that the vaccine must be kept frozen. An editorial with both articles makes an important point. It says the United States has a better process for vaccinating children than we do for teenagers and adults.

I think we're off to a good start with a safe vaccine for older adults. Clearly, now we need to translate the good science into good practice among doctors, insurance companies, and health policy makers.

What Changes Can I Make Now?

If you are over 60 and do not have a weakened immune system from AIDS, HIV, leukemia or lymphoma, you should strongly consider getting the shingles vaccine. People who are on high doses of steroids should not have this vaccine. Neither should anyone who is pregnant or considering pregnancy. Obviously, if you are allergic to anything in the vaccine, you should not have it either.

You are eligible and safe to get this shot even if you've had shingles before. You also can have the vaccine if you are not sure that you've ever had chickenpox (which is from the same virus that causes shingles).

Medicare D pays for this vaccine. So do many other insurance plans. Check with your doctor or insurance provider to see if it is covered. Since the vaccine has to remain frozen until just before use, it can be complicated to administer. Again, check with your doctor or local department of health to find out the best way to get it. At our hospital, we have set days when patients can be vaccinated. This allows for easier and safer administration.

Your Guide to Shingles