As a result of vigorous drug company advertising and recommendations made by several health organizations, many patients have come to me asking if I advise getting the shingles vaccine.
Shingles, also called herpes zoster, is a painful rash occurring on one side of the body only. It usually involves the chest or abdomen, but may affect any area, including the face. Direct involvement of the eye, though uncommon, is a medical emergency, since vision may be permanently impaired.
Shingles is due only to reactivation of the chickenpox virus that has been dormant in the body, usually for years. It does not occur by transmission from other individuals. Factors that impair immune function, such as physical or emotional stress, nutritional deficiency or steroid use, may activate the virus from its location within nerve cells, where it resides.
The shingles vaccine is effective in about 50% of vaccinated persons, but is less effective in older people. In persons over 80 years of age, it is only 20% effective. Duration of effect is considered to be about 5 years. Because it is a live virus vaccine, it should not be given to those with immune deficiencies, including people with leukemia, lymphoma, HIV, or on high doses of steroids or immunosuppressive agents. The vaccine does reduce the risk of post-herpetic neuralgia, pain that persists for more than 3 months after infection, by two-thirds.
Shingles can be treated effectively with the anti-viral agent acyclovir, Valtrex, or Famvir, if diagnosed early. In our practice we have also seen substantial benefits with intravenous vitamin C, ozone or ultraviolet light therapy, and with acupuncture. We have not seen an instance of post-herpetic neuralgia in years.
We will provide the vaccine if requested. However, I believe it is generally not necessary because of potent available therapies, and the limited rate of effectiveness.