Kalpna Patel, a pharmacist in the Central California city of Bakersfield, says she has administered hundreds of doses at her San Dimas Pharmacy. As consumers have discovered in other California communities and other states, the vaccine can be administered in pharmacies and doctors’ offices.
But the vaccine is expensive, when not covered by insurance. It also must remain frozen until injected. As a result, some physicians and pharmacies do not make it readily available. But that is not curbing the increasing demand.
“Shingles can be very painful. There have been cases that have caused blindness,” said Patel, adding that the federal Centers for Disease Control and Prevention recommends people who are over 60 years of age and who do not have disqualifying medical conditions receive the vaccine.
As people learn about the vaccine through the manufacturer’s advertising, or from their doctors, they are requesting it, said pharmacist Sylvia Ta, another Bakersfield pharmacist. Ta said anyone who has been exposed to chicken pox should be vaccinated.
Shingles is a viral disease that commonly strikes older adults. It is caused by the same virus that causes chicken pox in children. After exposure to chicken pox, the virus remains dormant, or “asleep” in nerve cells along the spinal column for decades.
As immune systems become compromised with age, or for other unknown reasons, the virus can reactivate, following a nerve to the skin’s surface, where it will appear as a painful rash.
Dr. Rafael Harpaz, a CDC epidemiologist, told National Public Radio that the painful blisters can travel to the face and into the eyes, where they can impair vision and even cause blindness.
“It can last for months and sometimes even years. It can be really life shattering,” he said. “I’ve heard stories of vibrant 62-year-old tennis-playing persons that end up being housebound and suicidal because of severe pain and not being able to interact socially and so forth.”
To hear NPR’s report, go to http://tinyurl.com/NPRshingles
Most people over the age of 60 have been exposed to the chicken pox virus. Although the vaccine to prevent chicken pox was developed in Japan in the 1970s, it wasn’t until 1995 that it was recommended for routine use in the United States.
Merck researchers estimate there are more than a million cases of shingles in the United States each year. The average person has a 30 percent chance of developing the condition in their lifetime.
Dr. William Schaffner, chairman of preventive medicine at Vanderbilt Medical School in Nashville, Tenn., gave this statistic perspective when he told NPR that almost half the people who reach 85 years of age will have experienced shingles at some point in their lives.
As with all vaccines, there is no guarantee that Zostavax will prevent shingles, said Patel. But its effectiveness has led the CDC to recommend it be given to people 60 years of age and older, who are more susceptible to shingles. It is uncertain if children now receiving the vaccine to prevent chicken pox will also carry the dormant virus and will need to be vaccinated to prevent shingles in their later years.
But a dose of Zostavax can be expensive if you do not have insurance, or your insurance does not cover the medication.
Because of the cost, the need to order the vaccine in volume and the need to keep the “live virus” vaccine frozen until it is administered, many local physicians and pharmacies to do carry it, Patel said.
Patel’s pharmacy is one of the few in metropolitan Bakersfield, where the vaccine can be purchased and administered. Patel said about 70 percent of the people who come into her pharmacy for Zostavax are covered by Medicare. Those who have not reached Medicare age and do not have insurance to pick up the cost pay $215 for the vaccine. Some insurance plans will only pay for the vaccine if it is administered by a physician.
At Ta’s pharmacy, a physician will request an order of Zostavax. When it arrives at the pharmacy, the patient will pick it up and take it quickly to the physician to be injected, or the pharmacy will deliver the medication to the doctor’s office so that it will be administered shortly after it arrives. This may require the patient to make two doctor’s visits.
Pharmacists and insurance providers urge people to read and understand their coverage before getting vaccinated. Medicare and many insurance plans will cover this relatively new vaccine. But how to get insurance companies to pay up may be hidden in the “fine print.”
With Vanderbilt’s Schaffner calling the vaccine a “major public health advance” for the 60-plus age group, Patel said getting an injection of Zostavax is worth the effort.
This article written by Dianne Hardisty appeared first in The Bakersfield Californian on Feb. 21. 2010.