You and the Shingles Vaccine

14 07 2011

Who should…and shouldn’t…get the shingles vaccine?

The virus that causes chickenpox, varicella zoster, doesn’t confine its activity to childhood. For reasons that remain unclear, it can re-emerge in older age as the rash called herpes zoster, more commonly known as shingles. Just as you can get chickenpox only once, usually you also have shingles only once. But that “once” can translate into chronic, unbearable pain if a complication known as postherpetic neuralgia develops. This pain, a burning nerve pain severe enough to disrupt sleep, can last for years.

That’s why people who are eligible for the shingles vaccine should get one. But who are those people?

The short answer is, almost anyone age 60 and over. The U.S. Food and Drug Administration has approved this vaccine only for this age group because researchers have no evidence yet that it’s effective in younger groups. It makes sense because one of the risk factors for developing shingles is . . . being over 60. Another risk factor is having had chickenpox before age 1.

The shingles vaccine is not, however, a substitute for the childhood vaccines against chickenpox.

Some people in the over-60 age group should not get the shingles vaccine. Avoid this vaccine if any of the following applies to you:

  • You’ve had a life-threatening allergic reaction to gelatin or the antibiotic neomycin. The vaccine contains other ingredients, so if you’re deathly allergic to something, check the ingredients list.
  • You’re taking drugs that suppress the immune system or have a disease that does, such as HIV, because this vaccine is a live-virus vaccine.
  • You have tuberculosis.
  • You are or might become pregnant, an unlikely possibility in the 60+ age group.
  • You are moderately to severely ill, including have a fever over 101.3 F. Wait to get the vaccine until you’re better.

Can you get this vaccine if you’ve already had the shingles? Sure, even though you’re not likely to get shingles again. You can also get this vaccine while receiving the influenza vaccine.

Like any vaccine or other medical intervention, the shingles vaccine can have side effects and carry risk. The most common side effects are pain and swelling at the injection site and headache. One large research study of the safety of the vaccine found no difference in rates of negative events between the vaccinated group and the group that received a placebo (a dummy injection). A substudy within that study, however, found a slightly higher rate of serious adverse events in the real vaccine group compared to placebo (1.9% vs. 1.3%). The data did not indicate that the events were vaccine-related.

The effectiveness of this vaccine depends on the outcome in question. Studies indicate that it reduces your risk of getting shingles by about 50%. If you do get shingles, the vaccine is linked to fewer days of pain during the outbreak and shorter periods of pain for people who go on to develop postherpetic neuralgia.

By Emily Willingham





Does Vaccination Prevent Cancer?

7 03 2011

The history of anxiety about possible negative effects of vaccines is long, tracing back at least as far as Benjamin Franklin. Countering these worries is the fact that vaccines are one of the greatest public health successes of our time, saving millions of lives worldwide.

Now we know that vaccine benefits may extend beyond prevention of the target childhood disease.

An already recognized extra benefit comes with the vaccines for varicella. A varicella vaccine not only can prevent chickenpox in young people, but may also stop the occurrence of shingles in older folks.

Shingles, a neurological attack by the chickenpox virus decades after an infection, can cause a rash that leaves behind chronic, unbearable pain. Vaccination in childhood may protect against shingles, and according to a new study from a Texas group, published in The Journal of Pediatrics, childhood vaccines may offer reduced odds of childhood cancer.

The researchers, going on hints from earlier studies, looked at vaccine rates in specific areas and compared those numbers to childhood cancer rates in the same region. While childhood cancers are rare, they are, of course, devastating. The most common cancers in children are leukemia and brain and spinal cord cancers. According to previous studies, some common childhood infections might increase a child’s risk of leukemia, while vaccinations might reduce that risk. It’s not a nutty idea that some infections—especially viral infections—might be associated with cancer. Indeed, a few viral infections have an established association, including human papillomavirus (HPV, associated with cervical and anal cancers), hepatitis B (associated with liver cancer), and Epstein-Barr (the “mono” virus, linked to a type of lymphoma).

The researchers looked at the 2800 cases of childhood cancer diagnosed in Texas from 1995 to 2006, focusing only on cases diagnosed in children two years or older. For every child diagnosed with cancer, the team identified four more children who had not had cancer, matched for age and sex. As a final step, they then mapped how many children from each group had been born in Texas counties with high vaccination rates.

Their results showed that where hepatitis B vaccination rates were high, odds of all childhood cancers fell by almost 20%. Where rates of inactivated polio virus, hepatitis B, or a specific mix of childhood vaccinations were high, odds of finding cases of a common childhood leukemia, acute lymphoblastic leukemia (ALL), dropped by as much as 38%. The biggest dip in odds came with higher rates of Hib (Haemophilus influenzae type b) vaccine and ALL, with a 42% decrease in ALL odds where Hib vaccination rates were high.

It’s important to remember that the authors didn’t establish a cause–effect link here. This study is based on the numbers, and the take-home message here is a simple one. The authors put it best in their abstract: “Some common childhood vaccines appear to be protective against ALL at the population level.”





Chickenpox Vaccine and Shingles – Two for the Price of One

20 12 2009

Kaiser Permanente completed a study that reviewed the health records of children who received the varicella (chickenpox) vaccine from 2002 to 2008. This study aimed to compare incidences of shingles in the vaccinated population compared to rates in the unvaccinated population.

Results found decreased rates of shingles in the vaccinated population. The study suggests that vaccinating children for chickenpox also reduces their chances of getting shingles, a secondary viral infection known as herpes zoster that typically results after primary infection with the varicella zoster virus.

Shingles is a very painful skin rash that develops from inactive varicella zoster virus that rests in nerve tissue near the spinal cord and brain. When stress or immune changes in the patient cause the virus to become active, the painful skin rash appears along the nerve.

Anyone who’s had shingles can tell you that it’s something to be avoided at all costs. Do your kids a favor, protect them from chickenpox now, and (possibly) the pain of shingles later.

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