The study also found that the vaccine’s effectiveness in reducing the incidence
of shingles drops with the age of the vaccine recipient. For example, Zostavax
was 64% effective for those age 60-69 years, 41% effective for those ages
70-79 years and 18% effective for those age 80 years or older. However,
the number of cases of shingles and PHN among people age 80 or older is
so high that vaccinating this population actually has major impact, according
to CDC. Considering how severely shingles can impact people, and the vaccine’s
reduction of the risk of developing PHN, this is considered an important
vaccine for older adults of all ages.
“The vaccine is more effective in people ages 60-69, so it is probably better
that they get vaccinated at that age,” said Megan Lindley, MPH, coordinator of
the Shingles Vaccine Implementation Group in CDC’s Immunization Services Division.
“Although it is not 100% effective, shingles is so common that having people
vaccinated against the disease should have a profound effect on public health.”
There are no contraindications for most older people with existing chronic
disease who may be taking medications. However, the vaccine should not be given
to people who have immunodeficiencies due to AIDS, leukemia, lymphoma or
malignant neoplasms affecting the bone marrow or lymphatic system.
As with most vaccines, common side effects include mild reactions (discomfort,
swelling or redness) at the injection site, headache or itching. No serious
problems have been identified from the shingles vaccine, CDC said.
Physician administration fees and other charges can bring the price for
consumers to somewhere between $165 and $300 per vaccination. That is
substantially more than older adults are used to paying for an influenza or
pneumococcal vaccine. Adult vaccine costs are approximately $11 to $15 for
influenza, $24 for pneumococcus, $180 for the three-dose series of hepatitis B,
$120 for the two-dose series of hepatitis A and $134 for the two-dose series of
varicella.
Starting in 2008, Congress required all Medicare Part D prescription drug
plans, which are administered by private contractors, to include all
commercially available vaccines not covered by Part B (which covers influenza
and pneumococcal vaccines). However, Part D participants may have to meet a
plan’s requirement for deductibles or copayments, and coverage may vary
depending on what stage of prescription drug coverage (initial coverage period,
gap or “donut hole,” catastrophic coverage) they are in. Starting in 2008,
vaccine administration fees also are covered under Part D.
MedPAC, an independent federal body that advises Congress on Medicare issues,
has suggested that Congress should permit coverage for appropriate preventive
vaccines under Medicare Part B instead of Part D. “If beneficiaries have to pay
the full payment rate for vaccines and then seek reimbursement from their plans,
physicians are concerned that the out-of-pocket cost will discourage
beneficiaries from seeking preventive care,” MedPAC told Congress in 2007.
Putting all vaccines under Part B would increase Medicare spending “by less
than $50 million for one year and by less than $1 billion over five years,”
according to MedPAC’s data.
Ongoing research will determine future policy decisions, such as possibly
lowering the recommended age for vaccination to 50, providing a “booster shot”
at some later time after the initial vaccination, using a higher dose of
vaccine or allowing vaccination of people with some degree of
immunosuppression.
RESOURCES
Age Page: Shingles, http://www.niapublications.org/agepages/shingles.asp
CDC Vaccines & Immunizations website, http://www.cdc.gov/vaccines/
Herpes Zoster Vaccine Q&A (Shingles), http://www.cdc.gov/vaccines/vpd-vac/shingles/vac-faqs.htm
Immunization Action Coalition, http://www.immunize.org/zoster/
Merck shingles website, http://www.shinglesinfo.com/
Merck Vaccine Reimbursement Support Center, 800-REIMBVAX, http://www.vaccinesupportservices.com
Merck Zostavax website, http://zostavax.com/
National Network for Immunization Information shingles vaccine information, http://www.immunizationinfo.org/vaccineInfo/vaccine_detail.cfv?id=54
Partnership for Prevention, http://www.prevent.org/content/view/106/54
Patient Information about Zostavax, http://www.fda.gov/cber/label/zosmer052506pi.pdf
Shingles (Herpes Zoster) Vaccination, http://www.cdc.gov/vaccines/vpd-vac/shingles/default.htm#patient
Shingles (Medline Plus), http://www.nlm.nih.gov/medlineplus/shingles.html
Shingles (National Institutes of Health), http://nihseniorhealth.gov/shingles/toc.html
Shingles (Zoster): Questions and Answers: Information about the Disease and
Vaccine, http://www.immunize.org/catg.d/p4221.pdf
Shingles Disease - Questions and Answers (Herpes Zoster), http://www.cdc.gov/vaccines/vpd-vac/shingles/dis-faqs.htm
Shingles Interactive Tutorial, http://www.nlm.nih.gov/medlineplus/tutorials/shingles/htm/index.htm
Shingles Vaccine: What You Need to Know, http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-shingles.pdf
Shingles: Hope through Research, http://www.ninds.nih.gov/disorders/shingles/detail_shingles.htm#96673223
Shingles: What Is Shingles, and Who Can Get It?, American Academy of Family
Physicians, http://familydoctor.org/online/famdocen/home/common/infections/common/viral/574.html
Spotlight on Shingles: Know What You Can Do, www.spotlightonshingles.com
Zostavax Questions and Answers, http://www.fda.gov/Cber/products/zosmer052506qa.htm
Zoster (Shingles) Vaccine, http://www.cdc.gov/vaccines/recs/adult-specinfo.htm#zoster
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