David Brownstein, MD
August 9, 2010
I frequently get asked by my patients, ” Should I take the shingles vaccine?” Shingles is a consequence of the chicken pox virus which becomes reactivated and causes a rash. Associated with the rash can be a painful condition called postherpetic neuralgia. A vaccine that avoids the onset of postherpetic neuralgia would be a worthy item.
Zostovex is a vaccine that contains live, attenuated chicken pox virus (varicella-zoster). It is the same vaccine given to children to prevent chicken pox, only it is approximately 14 times stronger in the adult version. It has been approved by the FDA for the prevention of shingles in adults 60 years of age or older. The [U.S. CDC's] Advisory Council on Immunization Practices has recommended Zostovex as a prevention of postherpetic neuralgia.
As previously mentioned, a vaccine to prevent postherpetic neuralgia sounds good. Is it effective? An article in The American Academy of Family Practice (6.15.07. Vol. 75, No. 12) summarized the research on this vaccine. The article reports a 50% decline in shingles and a 66% decline in postherpetic neuralgia with the use of Zostovex. The authors conclude that Zostovex “…is an effective vaccine that should be offered to patients who are 60 years and older.” But, further review of the data provides a much different picture.
For the prevention of shingles, 3.3% of unvaccinated persons developed shingles compared to 1.6% of vaccinated people. The “50%” claim that the article touted is the less-than-accurate ‘ relative risk’ level (calculated by the following formula–1.6/3.3). The more accurate ‘absolute risk’ shows a 1.7% decline (3.3-1.6) (source).
For the prevention of postherpetic neuralgia, the manufacture of the vaccine, Merck, touts a 39% decline with the use of the vaccine. Further analysis of the data might lead you to a different conclusion. Approximately 0.4% of unvaccinated persons versus 0.14% of vaccinated people developed postherpetic neuralgia. The 39% decline is the less-than-accurate ‘relative risk’ (0.14/ 0.4). If we looked at the more accurate absolute risk, we come up with a decline of 0.26% of postherpetic neuralgia in those that were vaccinated. The vaccine costs approximately $200.00.
So, for $200.00, we get a 0.26% decline in developing postherpetic neuralgia. I don’t think a 0.26% decline is anything worth spending nearly $200.00. What can you do? Keep your immune system strong to prevent shingles in the first place. Eat a good diet free of refined foods. In my practice, I have found Vitamin C IV’s very helpful for those that develop shingles/postherpetic neuralgia. Also, NAET, an acupressure treatment, has been very helpful for treating shingles and postherpetic neuralgia. Lastly, Vitamin B12 shots have also been very effective at eradicating postherpetic neuralgia.