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
Merck's 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-herpes 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 one
year, and in individuals whose immune system is weakened. The disorder is
common, with about 600,000 to one million cases in the U.S. per year. There
are an estimated 45-50 million Americans over age 60.
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 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%) for the treatment group
and 642 (3.3%) 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 it's
anti-viral derivatives that are far more profitable.
IN SUM
For the readers we suggest 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., wrote this week's commentary
