September 2008

Adult Immunization Update: Highlighting "Shingles" Vaccine
 

Blessings and greetings to you all as we begin the fall season….As the flu season approaches, it seems timely to review the latest updates for adult and “seniors” immunization recommendations in order to provide optimal protection against disease.   Several changes have been added to the former immunization guidelines--as well as more options now being available for immunizations outside the doctor’s office.

Safeway Pharmacy at the Sammamish Highlands now offers most of the current vaccines needed.  Many of these do not even require a prescription.  Patients must be at least 11 years old and have an appointment (available seven days a week) to ensure that both the vaccine and a qualified pharmacist are available for the injection.  Simply call their direct line at 425-868-6181 to schedule your immunization appointment.  (Special immunizations and anti-malaria drugs needed for international travel are also available at the Bellevue and Woodinville Safeway stores.)

Flu vaccines for the coming season are already available and are recommended to be administered ongoing, from the first of October.  (Free for those on Medicare Part “B”—for others the cost is $30)

For the older adult population specifically—the following vaccines are routinely advised:

Flu-vaccine, for those 50 and older, with high priority for ages 65 and older.

Pneumococcal vaccine, high priority for ages 65 and older—or adults of any age with chronic illness such as cardiac or pulmonary disease, chronic liver disease, alcoholism, or diabetes.

Tdap booster (newer form), advised for adult tetanus protection if no prior Td booster in 5 or more years—(also advised for any adults who have close contact with children younger than 12 months of age.)

Shingles (herpes zoster) vaccine –known as “Zostavax” ( more information following) –for those 60 and older.

(Note: For adults in specific living and work conditions, those traveling in non-industrialized nations, or those participating in high risk behaviors-- vaccinations protecting against Hepatitis B and Hepatitis A may also be advised.  Discuss these with your doctor.)

Many of you may not aware of the facts surrounding the need for shingles, or herpes zoster, vaccination. The FDA licensed Zostavax (shingles vaccine) in May 2006 to reduce the risk of shingles in people ages 60 and older.  Nearly 1 million Americans are afflicted annually by the disease, primarily affecting older adults who have had chickenpox as children, and about half of all adults who reach age 85 will be afflicted.  As baby boomers enter their 60’s the number of shingles cases will certainly increase.

Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox.  Following an attack of chickenpox earlier in one’s life, the virus lies dormant for years in specific nerve tissue called sensory ganglia.  The incidence of the disease increases in adults as they age, affecting the older adult as a reappearing virus in the form of “shingles”.  Shingles is characterized by a painful rash, often with clusters of blisters that can cause severe pain lasting for weeks, months --even years.  This cycle of persistent burning pain (called postherpetic neuralgia or PHN) develops in about 35% of those affected with shingles after age 60, and can lead to significant disability, depression and compromised quality of life.  Other symptoms of shingles can include fever, headache, and stomach problems. Rarely, a shingles infection can lead to pneumonia, hearing loss, blindness, encephalitis (brain swelling) or death.

Zostavax is the live virus, anti-shingles vaccine given in a single injection, just under the skin (usually in the upper arm).  No serious problems have been reported with the shingles vaccine.  However, commonly-reported side-effects include redness, pain, tenderness, and/or mild swelling at the injection site.  Less frequently reported are short-term itching and headaches following the vaccination. According to a recent study, the vaccine markedly decreased not only the incidence of shingles, but also substantially reduced the severity of the symptoms and degree of pain (PHN) in those who developed shingles. 

Calling ahead for pharmacy appointments to receive Zostavax is necessary due to the vaccine’s fragility under storage. Because it needs to be kept deeply frozen until reconstituted with sterile water, (and then given within 20 minutes) it is rarely available at the doctor’s office.  For those adults age 60 and older—no prescription is needed, and the out of pocket cost is about $30-35 if the patient has coverage under Medicare Part “D”—as well as with some other premium insurance plans.  For those without insurance the cost for the Zostavax is $210.

 Although well tolerated in older healthy adults, the vaccine is not recommended for those patients whose immune system is compromised—those with cancer, those treated with steroids, radiation, or chemotherapy, or those with HIV infection.  Those with a history of allergies to other vaccines should discuss the risks with their physician.

As with immunizations for any age group, it is important to weigh the benefits and the risks.  Routine vaccinations are generally safe, and the risks of the vaccines are much smaller than the risks of the diseases, with side effects usually mild. That said, patients with complicated medical histories should always discuss immunization guidelines with their own physicians before proceeding.

Hope to see each of you at our team-sponsored blood pressure screenings as we resume our fall monthly schedule!

The SHLC Parish Nurse and Health & Wellness Team Ministries