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Thursday August 17, 2017

Older Adults Need Their Shingles Vaccine

Christmas

At some point in their lifetime, one in three Americans will get shingles, a very painful reactivation of the chickenpox virus. It generally lasts for at least a month, and can even develop into a longer-term condition called post-herpetic neuralgia, in which the sensation of burning and aching, as well as sensitivity to touch, can continue for years.

The disease is more common in mature adults, which is why the CDC recommends the shingles vaccine for people older than 60. Yet only a third of people age 65 are vaccinated, the Philadelphia Inquirer recently reported. The reason appears to be a combination of cost, insufficient information going to doctors and patients, and perhaps the mistaken perception that the vaccine isn’t helpful enough to bother getting.

It’s true that the shingles vaccine isn’t as effective as the immunizations against measles (97 percent) or whooping cough (88 percent). Half of the people who get it will be protected. The vaccine also is less effective in older senior citizens—41 percent for people 70 to 79 years old, and only 18 percent effective for those older than 80. Those who have had the vaccine, though, might experience milder symptoms.

 “While the vaccine was most effective in people 60 through 69 years old,” the CDC reported, “it also provides some protection for people 70 years old and older.”

In addition, a 2016 study found that its effectiveness waned to insignificance eight years after it was administered.

Still, with a million cases of shingles in the country every year, and particularly high rates of the disease among people 80 and older, the vaccine makes a real difference in the numbers of people who fall ill, and would make a bigger one if more people were immunized.

Perhaps people will be more likely to embrace immunization against shingles if the FDA approves a new vaccine that has shown promising results so far, the Inquirer article says. A 2016 study published in the New England Journal of Medicine found that two doses of the newer vaccine were 90 percent effective in people in their 70s, and almost as effective in people in their 80s.

But that doesn’t fully answer the question of why more people aren’t vaccinated now. Even if a new and more effective vaccine becomes available, studies have found that it would still work for people who had previously gotten the current vaccine. There’s no medical reason for most older people not to get the vaccine.

A big reason for the low vaccination rate, which would not necessarily be solved by a new vaccine, is the way people are charged for the shingles vaccine.

“While Medicare covers other adult vaccines as Part B medical benefits, the shingles vaccine is covered under the Part D prescription program, which is optional,” the Inquirer article says. “Some seniors don’t buy Part D, and doctors can’t easily use it to get reimbursed for their office services.”

The full price for the current vaccine is about $200, the news outlet reported.

William Schaffner, an infectious-disease specialist at Vanderbilt University Medical Center in Nashville, told the Inquirer: “Congress, purely for fiscal reasons, put the shingles vaccine into the prescription plan. That has been far and away the biggest barrier to uptake of the vaccine.”

During this third week of National Immunization Awareness Month, it’s worth considering how we can make vaccines for older Americans more affordable, but also how public health officials can help those Americans understand that a 50 percent effectiveness rate means that thousands and thousands of people could be spared this painful and sometimes debilitating disease.

 

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