In 2005, a super-potent varicella-zoster vaccine established a 50% reduction in shingles over a 3 year period but left disturbing issues over whether the increased strength was necessary or a marketing ploy. Recent Zoster immunity testing locally cast doubt on test’s validity.
Oxman M, Levin M, Johnson G,Schmader K, Straus M, Gelb L, et al.
A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.
NEJM 2005;352(22):2271-84.
This study left suggestions that elderly, particularly aged 60 -70 should be vaccinated with the now FDA approved varicella-zoster vaccine (Zostavax). Some argue there is no evidence for needing the increased potency of the vaccine – particularly in subjects who have probably have a spark of previous immunity. Local reaction with the vaccine were very common – (48.3% vs. 16.6% for placebo) reminding me of what happens when you give TD vaccination to someone who has had it under 5 years prior. I would say – give the much cheaper Varicella vaccine and test immunity.
Now here’s the problem – I had a child whose mother wanted him to have a varicella vaccine. I suggested we check for immunity and the lab test return showing Zoster “Immune” – NO TITER LEVEL GIVEN. 2 weeks later he contracted chickepox and his IgM levels converted positive – much to suprise of our lab. It was suggested they were going to look into it but my feeling without a titer to go on, there is no point in testing for immunity.
I once read that the post-zoster neuralgia levels are the same as your age. With present treatments, that might not be accurate but that much pain in a elderly subject can kill their quality of life if not them as well.
I would suggest that all subjects 60-70 years old willing to put up with local reactions be vaccinated using the regular vaccine. It would probably have less local reaction and might be enough. Then there is the question of whether it would be worthwile to test for Zoster levels after….
Any comments would be appreciated..
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