Who should receive the shingles vaccine?

The Advisory Committee on Immunization Practices (AICP) recommends routine vaccination of all patients 60 years and older.

Immunity decreses with age
More than 1 million cases of Zoster are estimated to occur in the USA. The elderly population is at risk because the immunity toVZV decreases with aging. More than 50% of people who reach age above 85 develop shingles at some point and 20 % of these patients develop postherptic neuralgia.

Is vaccination effective?
The shingles prevention study included more than 38,000 adults with median age of 69 years with a follow up for a mean of 3.13 years after receiving the vaccine. The vaccination significantly reduced the incidence of zoster by 51 %(p<.001), and the incidence of postherptic neuralgia by 66%. The live attenuated vaccine did not result in acute shingles in vaccinated subjects. If lesions did occur, they were from the patient's own native strain.

Is it imoportant that the vaccination decreases the incidence of postherptic neuralgia?
Yes. Antiviral therapy reduces the severity and duration of an episode of shingles but does not prevent postherptic neuralgia. Steroids also do not clearly prevent postherptic neuralgia. Steroids can only provide some pain relief during an acute episode when used with antiviral medications. The vaccine prevents postherptic neuralgia and improves the quality of life in vaccinated elderly population.

Zostavax
Zostavax is manufactured by Merck and is currently the only vaccine available for use. It was approved by the FDA in May 2006 for prevention of herpes zoster in people aged 60 and older. It must be kept frozen at all times until it is used. No booster is recommended at the present time. This vaccine is different from the Chicken Pox vaccine (Varivax) and should not be used as an alternative. Zostavax is 14 times stronger than Varivax. However, they are both live attenuated vaccine from the same strain of the virus.

I had zoster before, should I receive the vaccine?
People with history of zoster can be vaccinated as recurrent zoster has been documented in immunocompetent hosts. The vaccine can also be given to people who do or do not recall having chickenpox during childhood. Therefore, serological testing to determine varicella immunity is not needed before vaccination.

Any contraindication for vaccination?
History of treated cancer including leukemia or lymphoma is not a contraindication. In addition, humoral immunodeficiency is not a contraindication to vaccination. There is no age limit for vaccination and common medical problems such as diabetes or heart failure do not perclude active vaccination with Zostavax.
 * Active cancer treatment with chemotherapy or radiation
 * Leukemia
 * Lymphoma
 * Organ transpalntation
 * Active tuberculosis
 * Pregnancy or breastfeeding
 * Severe allergy to gelatin, neomycin, or any component of the vaccine
 * AIDS or other cellular congenital and acquired immunodeficiency states

I take Zovirax, can I receive the vaccine?
Anti-herpes medications need to be stopped at least 24 hours prior to receiving Zostavax and should not be started until 14 days afterward.

Is Zostavax a costy vaccination?
Zoster vaccine cost about $155 per dose. The outpatient treatment of zoster costs about $200 whereas hospitalization for acute zoster costs between $3,221-7,206. Evidence suggests that zoster vaccination is as cost-effective as other public health intervenbtion. Despite this, most insurance companies do not cover for Zostavax. In several states, only medical doctors are licensed to administer this vaccination. This adds to the cost and the inconvenience of administering this vaccine. The patient has to buy the vaccine form the pharmacy, place it in ice, and bring it back to his or her physician for the SC administration.

--Johnfanisrour 00:20, 12 January 2009 (UTC)john fani srour--Johnfanisrour 00:20, 12 January 2009 (UTC)