by Mary Govoni, CDA, RDH, MBA
If you or someone you know has ever suffered through an outbreak of shingles, you’ll be interested to know that the U.S. Food and Drug Administration recently approved a new herpes zoster vaccine, known as Zostavax®. The vaccine is formulated to reduce the incidence of shingles, caused by the varicella zoster virus (VZV). It is a weakened, live virus vaccine. Shingles is not an occupational hazard for dental professionals; however, patients may have heard about the vaccine and have questions about whether they should receive it.
Shingles manifests itself as a very painful skin rash, commonly occurring on one side of the face, neck, or chest, often accompanied by blisters. People often experience pain, tingling, or itching in an area prior to the rash appearing. The rash usually lasts from two to four weeks, but symptoms can last longer. Individuals experiencing a shingles infection may also experience chills, fever, headache, and stomach upset. In rare cases, a shingles infection can cause pneumonia, hearing problems, blindness, encephalitis (inflammation of the brain), and even death. Some individuals continue to experience severe pain after the rash goes away, referred to as postherpetic neuralgia or PHN. The Centers for Disease Control and Prevention estimates that at least 1 million people each year get shingles in the United States alone. If you had chicken pox as a child or received the chicken pox vaccine, you may get shingles, especially as you age.
More common in people age 50 and older, shingles is caused by a reactivation of the varicella zoster virus. People with weakened immune systems, such as cancer patients and those taking steroids, are more susceptible to shingles. Although shingles is not contagious, it is possible, but very rare, for a person who has not had chicken pox or who has not received the chicken pox vaccine to get chicken pox from someone with a shingles infection. Although shingles most commonly occurs only once in a person’s lifetime, in rare cases it can recur. Persons experiencing a painful shingles infection can be treated with antiviral medications such as Zovirax®, Valtrex®, and Famvir®. To be most effective, the medication needs to be started as soon as possible after the rash appears. These medications have been shown to shorten the length of the illness and alleviate the symptoms.
Clinical trials of Zostavax® indicated that the vaccine was effective in preventing shingles infection in about half of the individuals who received it. The vaccine was tested in individuals 60 years of age and older, since they are the most susceptible to an infection. In addition to preventing infections, the vaccine was also shown to reduce the pain associated with outbreaks of shingles. The vaccine is administered in a single dose.
Merck, the vaccine’s manufacturer has a Web site about Zostavax® — www.zostavax.com — which includes information about the vaccine, risks and reactions, and a list of individuals who should not receive the vaccine. The vaccine should not be given to anyone who has experienced an anaphylactic reaction to gelatin, neomycin, or any other component of the vaccine. The vaccine also should not be given to individuals who have weakened immune systems due to HIV/AIDS, are taking steroids or other immune suppressants, are undergoing cancer treatment (chemotherapy or radiation therapy), have a history of leukemia or lymphoma, have active tuberculosis, or are pregnant. Although the vaccine’s manufacturer reports no serious problems associated with Zostavax®, both the manufacturer and the FDA are monitoring it. Typical reactions to the vaccine that have been reported are redness, swelling, soreness, or itching at the injection site and headaches.
According to the CDC, other reactions to be on the alert for include difficulty breathing, dizziness, weakness, paleness, hoarseness or wheezing, hives, and/or a fast heart rate. These signs of allergic reaction typically occur within the first few hours after injection.
In addition to the material on the Merck Web site, information about shingles and the vaccine is available at www.cdc.gov, www.webmd.com, www.ninds.nih.gov/disorders/shingles/shingles, and www.mayoclinic.com/health/shingles. You can also contact your family physician or your county health department.
The approximate cost of the vaccine is said to be $150 for the single dose. In some areas of the country, some managed-care insurance plans are strongly recommending that people age 60 and older get the vaccine. In other areas, insurance plans are not providing benefits for the vaccine, requiring individuals to pay out of pocket to be vaccinated. Since the vaccine is still new, it remains to be seen how widely accepted it will become and whether insurance plans, such as Medicare, will provide coverage for at-risk individuals.
If you or a family member meet the criteria to receive this vaccine, it certainly warrants further investigation and consultation with your physician to determine whether it is appropriate.
About the Author
Mary Govoni, CDA, RDH, MBA, is the owner of Clinical Dynamics, a consulting company based in Michigan. She is a member of the Organization for Safety and Asepsis Procedures and is a featured speaker on the ADA Seminar Series. She also writes a column for Dental Office magazine. She can be contacted at [email protected].