chicken pox


The Scariest Reason To Get The Shingles Vaccine

Shingles rash on the chest of a 90-year-old man (Courtesy of Merck)

Shingles rash on the chest of a 90-year-old man (Courtesy of Merck)

First came several hours of blackest end-of-vacation stress. Not over anything truly serious, just garden-variety panic, as in, “We forgot the wallet and we’re late for the plane but just took the wrong exit for the airport.” It brewed inside me for hours amid my self-recriminations on the endless flight home.

Then, as we were finally filing off the plane, I felt a prolonged itchiness on the left side of my torso. Discreetly peeking under my shirt, I found a cluster of red pinpoints, sprinkled in a strip near my navel. “Oh, hell, not this too,” I thought. “Maybe it’s shingles from all that stress. I knew I should have gotten that shot.”

Shingles, in case you’ve missed all the vaccine ads on TV and in drugstores lately, is an often excruciating, blistery rash caused by the reactivation of the chicken pox virus that lies long dormant near your spine after your childhood chicken pox. It hits about a million Americans a year. The TV ads have a horror-movie ring, warning that the virus “may already be inside you.” A tough-looking firefighter tells you it was the worst burning sensation he ever encountered, and “it is bad.”

Think of it as ‘Extended Release’ shingles. Or as the closest thing to the trials of Job for an unlucky few.

Ha. I scoff at those ads. I’m not scared of shingles. Sure, I’ve heard the pain compared to third-degree burns and medieval torture, and very rare complications can cause blindness or affect the brain. But it generally lasts no more than several weeks, and that’s just not a frightening enough prospect to energize me to get an extra vaccine. Especially one that can cost me $185 even at a Costco pharmacy (which I know because I just called.)

No, the reason my heart dropped when I saw my rash — and the reason I am now going to pay out of pocket for the vaccine because my health insurance covers it only for those over 60 — is an affliction even less familiar to most people than shingles. It is called postherpetic neuralgia. Think of it as “Extended Release” shingles. Or as the closest thing to the trials of Job for an unlucky few.

We have a family friend whose epic case poisoned his life for years, but at my request, Dr. Anne Louise Oaklander, a Massachusetts General Hospital neuropathologist and researcher, refreshed my fear. Her postherpetic neuralgia patients, she said, “tell me that every day is spoiled, and that they are in chronic pain,” sometimes for years — pain so bad that it can lead to depression and job loss and isolation. In rare cases, even suicide.

“Shingles is no fun,” she said, and its rare complications can be serious, “but it passes,” and “the reason to get the vaccine is to avoid postherpetic neuralgia,” which affects 10 to 20 percent of people 60 and above who get shingles. Rates rise rapidly with age.

On the fence

At age 52, I’ve been on the fence for a while about getting Zostavax, the shingles vaccine. Though the FDA approved it in 2006 for virtually everyone over 50, Zostavax has been slow to catch on, hindered by supply shortages and other challenges. More on that later. But Merck, which makes Zostavax, says the pace is picking up.

“We shipped a lot more vaccine in 2012 than in 2011, almost double the amount,” said Dr. Eddy Bresnitz, the executive medical director for adult vaccines at Merck.

Should you, too, get on that bandwagon? The answer is a deeply personal decision — ideally, in consultation with your doctor, of course. It’s even more personal than most vaccine decisions, because shingles is not generally infectious, so you don’t have to factor in good citizenship.

Rather, your choice may hinge more than anything else on your age, your money, and what you fear, or don’t. Continue reading