Cost of shingles vaccine hurts, but sufferers say pain of disease is worse

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Jack Thomas jokes about how badly behaved a class he taught 20 years ago was -- to the point it made him ill -- but the disease he suffered was no laughing matter.

Thomas had herpes zoster, commonly known as shingles.

“It’s a very painful disease,” said Kevin Thomas, health officer of the Cape May County Department of Health and younger sibling of Jack Thomas. “My brother had it, and as soon as I hit 60, I’m getting the vaccine.”

Today, Jack Thomas is a 65-year-old retired teacher living in Runnemede, but when he suffered his bout of shingles, Zostavax didn’t exist. Merck is the sole manufacturer of the vaccine, which has been available to those 60 years of age and older since 2006 and at the county health department for the last three years, said Natalie Sendler, R.N.

Even if the vaccine had existed two decades ago, Jack Thomas – at age 45 -- wouldn’t have fit the demographic at which it is aimed. Sendler, who has worked for the county since 2000, said the Food and Drug Administration approved the vaccine for those 50 years and older within the last year, and that the Center for Disease Control’s Advisory Committee on Immunization Practices is expected to follow this month.

Shingles symptoms

The years have not dimmed Jack Thomas’s memory of the pain associated with shingles, which lives in the nerve endings and blisters the skin in the same manner in which chicken pox does. Anyone who had chicken pox as a child carries the virus, which can flare up as the adult form of shingles from such triggers as stress or a weakened immune system.

“I was teaching elementary school -- it was a bad class that was getting on my nerves -- and one night, around 1 or 2 in the morning, I felt like I was having a heart attack,” Jack Thomas said. “The pain was right around my chest.”

It wasn’t cardiac arrest. His physician diagnosed it as shingles, based on Thomas’s symptoms and the rash that broke out around his rib cage and lasted for six months.

“I wouldn’t want to get it again,” Thomas said.

He could, though. An episode of zoster does not provide immunity against the disease, any more than the vaccination does. The advantage to getting the vaccine, Sendler said, is it will lessen duration of the disease.

Once an outbreak occurs, the patient should begin treatment with an anti-viral medication as soon as possible, Sendler said, as that, too, will shorten the outbreak.

“I know more people who have had shingles twice than just once,” said Len Smith, moderator of monthly TED talks at the Ocean City Free Public Library, who received the vaccine in January 2009. “The last person to have it found the second episode much more severe than the first one.”

The Centers for Disease Control reports 3.2 to 4.2 people per 1,000 will get shingles, with approximately 1 million cases occurring annually in the U.S. In populations older than 60, the incidence jumps to 10 per 1,000 people.

An estimated 32 percent, or one in three people, in America will suffer herpes zoster during their lifetime.

Data on recurrence rates are limited, although the CDC reports studies suggest “a high incidence of zoster recurrence” and that there is “no evidence that an episode of zoster protects against recurrence.”

Sendler said the worst complication of shingles is post-herpetic neuralgia, which is signaled by sharp, throbbing pain beyond the area of the original rash. People who suffer this complication have skin that is very sensitive to touch and temperature.

“They can become debilitated by it,” she said.

In Cape May County, which has the state’s largest percentage of residents older than 65, shingles is a hot topic.

“It’s more on people’s radar,” said Kevin Thomas, attributing increased interest to television and print ads for Zostavax.

“My comments on shingles generated more response than all other emails combined this year,” said Smith, who piqued members’ interest last month with an email that put the cost of the vaccine at $230.

Where to get Zostavax

Sendler said a shot of Zostavax costs anywhere from $175, which is what the county health department charges, to $300 elsewhere. She said it is so expensive because there is no generic vaccine, only the brand-name one, which is made from the chicken pox virus and frozen. Prior to administering, the vaccine must be defrosted.

Most physicians do not offer Zostavax because they must purchase it in lots of 10 at a cost of $160 each, and many fear the vaccine will expire before they use it all, Sendler said.

Pharmacies at some drug stores and grocery stores will administer the shot, as will the county health department. In all cases, patients should provide a prescription from their physician at the point of immunization.

Sendler said Medicare A & B will not cover the cost of the vaccine, but Medicare D will. She said the county can provide the vaccine at low cost to those with Medicare A & B and no insurance through a federal program. The county does not bill insurance companies, so those with insurance must pay for the shot and obtain a receipt to submit for reimbursement.

Also, not all insurance companies will pay for the vaccination.

To make an appointment with the county health department, call 465-1200.

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