Military Officer - April 2008 - (Page 52) askthedoctor Shingles Vaccine In 2006 the FDA approved a herpes zoster vaccine to help prevent shingles. It is recommended for many people over 60 years of age. By Rear Adm. Joyce Johnson, D.O. S Check Your Health Plan Coverage I TRICARE covers the herpes zoster vaccine under its health care benefit. Medicare Part D also covers the vaccine. Consult “TRICARE UPDATE” (January 2008, page 24) for details. hingles (also called herpes zoster, after the virus that causes this condition) can affect anyone who has had chicken pox. The varicella zoster virus causes chicken pox; it remains dormant in the body after the acute chicken pox disease is over. Years after the original infection, this virus sometimes reactivates in the form of shingles. The reactivated virus causes a skin rash with pain and inflammation, often along the nerves by the ribcage on the torso. The pain can be debilitating. Usually the pain resolves after several weeks, but about one-fifth of those with shingles have a very prolonged course, with pain lasting for months. This chronic pain is called post-herpetic neuralgia. Shingles can be treated with antiviral and pain medications, but some people have a very limited response to treatment. The rate of shingles increases with age. It also is more common in people whose immune systems are suppressed (such as those who are HIV-positive or undergoing cancer treatment). The vaccine that helps prevent shingles is made from a special live virus that is similar to the chicken pox virus that causes shingles. However, this special virus doesn’t cause any illness. The vaccine is recommended for many adults age 60 and older. Clinical trials for the vaccine’s approval included people aged 60 and older, which is why the FDA established this age limit. The vaccine is somewhat less effective in people in their 70s and 80s, probably because of their natural, age-related reduced immune responses. Only a single dose of the vaccine is needed. Overall, clinical trials showed shingles was reduced in about half the people receiving the vaccine. Vaccinated people who got shingles anyway had milder cases and were less apt to have chronic pain from post-herpetic neuralgia. This means that, if you receive the vaccine, your chances of getting shingles will be cut in half — and if you do get shingles, you probably won’t have as severe a case as you might have without the vaccine. The vaccine is contraindicated in some people. Since it is a live virus vaccine, it should not be administered to people with immune deficiencies, such as patients who are HIV-positive, those undergoing cancer treatment (either chemotherapy or radiation therapy), those with a history of bone marrow or lymphatic system cancer, or those with active untreated tuberculosis. Before getting the shingles vaccine, check to make certain it will be covered under your health plan. Both TRICARE and Medicare cover the vaccine, though with some restrictions. MO — Rear Adm. Joyce Johnson, USPHS-Ret., D.O., M.A., is vice president, Health Sciences, Battelle Memorial Institute, Arlington, Va. Find more health and wellness resources at www .moaa.org/wellness. For submission information, see page 20. PHOTO: STEVE BARRETT 52 MILITARY OFFICER APRIL 2008 http://www.moaa.org/wellness http://www.moaa.org/wellness
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