In May 2006, the Food and Drug Administration (FDA) announced it had approved Zostavax [Zoster Vaccine Live (Oka/Merck)] to prevent shingles or reduce the pain associated with shingles in those 60 years and older. The safety and efficacy of a single dose was demonstrated in a landmark clinical trial published in 2005. This trial involved over 38,000 individuals, 60 of which who had never had shingles. While the virus that causes shingles is the same one that causes chickenpox, this new vaccine (Zostavax) is not the same used to prevent chickenpox (Varivax). Zostavax is not recommended for children. It is not indicated for treating either zoster or postherpetic neuralgia, nor is it for those who are immunosuppressed or on immunosuppressive therapy. The duration of protection is also unknown, and it has not been studied in those with a previous history of shingles.
The first infection with the varicella zoster virus (VZV) is commonly called chickenpox and most often affects children under age 12, although it can occur at any age. It is highly communicable via respiratory droplets (e.g. coughing, sneezing) as well as through direct or indirect contact with drainage from the characteristic rash or lesions. The symptoms, while annoying, tend to be mild. Chickenpox generally results in lifelong immunity. However, the virus may remain dormant in the sensory ganglia (a swelling of neurons along the course of a peripheral nerve). In a proportion of older adults, VZV may reactivate from the latent state and cause herpes zoster, also known as shingles. Shingles is not as contagious as chickenpox, and while it also manifests as a rash, the presentation is markedly different. The rash is localized in a unilateral distribution following the line of the affected nerve or dermatome and leads to painful blisters and sores on the skin. It is often associated with severe neuropathic pain, which can last long after the disappearance of the rash. The most common site is a dermatome spanning one side of the trunk around the waistline. However shingles can involve any part of the body. As a person moves past 60 years of age, the chance of reactivating VZV or experiencing intense pain associated with the rash tends to increase.
Herpes Zoster in the older person can be very debilitating and significantly interfere with one's ability to perform the normal activities of daily living. The pain can last for months or even years, and sensitivity can range from mild irritation to exquisite pain. Due to pain, disability, or disfigurement, shingles can result in isolation for those affected. This new vaccine may bring a promise of an extended quality of life and reduce the fear of painful shingles in the most elderly of our population.