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Shingles, or herpes zoster, is a vesicular skin eruption, usually accompanied by moderate to severe pain. Shingles can severely limit activities of daily living, including eating or even moving.

About 10 percent of the population will develop shingles during their lifetime; for persons older than 85 years, the risk is about 50 percent. Complications develop in 15 percent to 40 percent of cases, such as postherpetic neurolgia (persistent pain after resolution of the rash); ocular, or visual, loss; and dermatologic conditions (pigmentary changes, bacterial superinfection). Shingles and PHN are much more common in persons older than 60 years. PHN can persist for months or years, significantly affecting all areas of life.

The shingles virus is a consequence of a previous chicken pox infection. After a bout of chicken pox, the virus survives in a dormant state in the nervous system. Waning immunity may be at the core of the virus re-emerging and causing shingles later in life. Shingles is much less contagious than chicken pox and is not transferable to others. However, a person who has never had chicken pox or the varicella vaccine could get chicken pox from someone with shingles.

The Advisory Committee on Immunization Practices last October recommended adults 60 years and older receive the new vaccine Zostavax to prevent shingles and reduce PHN. Widespread use of Zostavax should significantly reduce the burden of suffering from shingles, PHN and hospitalizations for HZ disease. The duration of protection is unknown but appears to be at least five years.

The studies for Zostavax enrolled more than 38,000 people 60 years and older, who were followed for three years. Overall, researchers found the vaccine prevented shingles by 50 percent. The vaccine effect was highest at 64 percent in people between the ages of 60 and 69, but its effectiveness declined with increasing age to 41 percent for the 70 to 79 age group and to 18 percent for those 80 years and older. It is notable that while the vaccine effect declined with age, the risk of PHN was lower among those older vaccinated persons who still developed shingles.

The Zostavax vaccine is a live attenuated vaccine given as a single dose. Studies found the most common side effects were mild, such as soreness at the injection site and headache. The vaccine is contraindicated for anyone who has had a serious allergic reaction to gelatin or neomycin (an antibiotic), has a weakened immune system such as leukemia, lymphoma or HIV/AIDS, is taking high doses of steroids or has untreated active tuberculosis.

Zostavax is an expensive vaccine at more than $200 per dose. As of this writing, there is no ready mechanism for physicians to bill for Zostavax under Medicare's Part D. Since physician's offices are considered to be out-of-network providers for Part D, they must follow out-of-network rules. If a patient receives the Zostavax vaccine in a physician's office, the patient must pay for the Part D-covered vaccine cost and submit a paper claim for reimbursement to their insurance company or Medicare Part D plan.

Medicare still is working out different strategies for billing for Zostavax. More information on the Centers for Medicare and Medicaid Services can be found at www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/BvsDCoverage_07.27.05.pdf.

Further information may be obtained from your physician, the Northwest Colorado Visiting Nurse Association or the Centers for Disease Control and Prevention at http://www.cdc.gov/nip/vaccine/zoster/default.htm.