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Is Shingles Vaccine Right for You? Michael Arnold Glueck, M.D., and Robert J. Cihak, M.D., The Medicine Men The Issue The Advisory Committee on Immunization Practices (ACIP) has recommended that Americans 60 and older receive the recently approved Merck vaccine against Herpes zoster (shingles). Zostavax is described as a "souped-up version" of Merck¹s chickenpox vaccine for children, containing a live virus that is 14 times more potent But should all seniors over 60 rush to inoculation? Herpes zoster Herpes zoster is an acute localized infection with varicella-zoster virus, which causes a painful blistering rash. Shingles is caused by the same virus that causes chickenpox. After an episode of chickenpox, the virus becomes dormant in the body. Herpes zoster occurs as a result of the virus re-emerging after many years. Post-herpetic nerve root pain may last for years. Herpes zoster may affect any age group, but it is much more common in adults over 60 years old, in children who had chickenpox before the age of 1 year, and in individuals whose immune system is weakened. The disorder is common, with about 600,000 to 1 million cases in the United States per year. There are an estimated 45-50 million Americans over age 60.
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To Inoculate or Not In their October 28, 2006 news release on the shingles vaccine, the Association of American Physicians and Surgeons (AAPS) decided not to take a pro or con stance on this issue – but rather a Fox News-like approach of "Here are the facts – you make the decision." In a study of 38,000 persons, half of whom received the vaccine and half of whom received a placebo, "people who got the shot developed shingles at only half the rate of those who got the fake vaccine," reported the Associated Press (Arizona Daily Star 10/26/06). The actual number of shingles cases was 315 (1.6 percent) for the treatment group and 642 (3.3 percent) for the placebo group (Oxman MN et al. N. Engl. J. Med., 2005; 352:2271-2284). The price of $150 is expected to hurt demand for the vaccine. Medicare is supposed to start paying for the vaccine in January, but it will be treated as a prescription drug, and Medicare will not pay physicians an administration fee. Pharmacists are being urged to add Zostavax to the menu of vaccines they administer to adults (San Francisco Chronicle, 9/26/06). Joel M. Kauffman, Ph.D., reviewed the adverse affects sub-study performed on one-sixth of the Zostavax study subjects. Extrapolating the results to the entire study population, he noted that the treatment group had 132 more cases of serious adverse events, and 4,677 more cases of one or more adverse events than the placebo group.
Recalling early reports of successful treatment of symptomatic shingles with intravenous Vitamin C, Kauffman notes, "Since intravenous sodium ascorbate is known to be quite safe, treating only those patients who develop clinical manifestations of shingles would seem to be a far better approach, both medically and financially, than mass vaccination with a large number of adverse effects, if this treatment is as effective as has been stated" (Kauffman, J.M., J. Am, Phys. Surg., 2005:10:117). Jane Orient, M.D., Tuscon, Arizona, reported successful treatment of shingles with high doses of Vitamin C ("Treating Herpes Zoster with Vitamin C: Two Case Reports") in the J. Am. Phys. Surg., Spring 2006. To C or Not to C This raises another interesting point for curious minds. If high doses of Vitamin C have been effective against Herpes zoster,might they also be effective against Herpes simplex (genital herpes)? Genital herpes is a highly contagious sexually transmitted disease. The cause is a strain of the Herpes simplex virus. Genital herpes may be extremely painful and embarrassing. We may never get the answer, as drug companies are unlikely to fund a double-blind study with vitamin C since they already market Acyclovir and its anti-viral derivatives, which are far more profitable. Summary We suggest that you weigh the facts and check with your personal physician (family practitioner or internist) and make an informed decision that is right for you. Editor's Note: Michael Arnold Glueck, M.D., submitted this week's column. Contact Drs. Glueck and Cihak by e-mail. Michael Arnold Glueck, M.D., Newport Beach, Calif., writes on medical-legal and allied ethical issues locally and nationally. Robert J. Cihak, M.D., is a senior fellow and board member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons.
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