I had shingles about six years ago as a side effect from cancer treatments and a bone marrow transplant. My immune system was obviously comprimised, so I was given Valtrex as an antiviral as a precautionary treatment. Unfortunately, I was a bad patient and didn’t take my medicine so ended up with shingles. My punishment for this was to take lots more Valtrex. The shingles eventually went away and I took my medicine after that.
While I had the shingles, however, I took a drug called Neurontin for the pain. I’m interested if anyone else has been prescribed this. For me, there was very little, if any, pain and I only felt a vague itchy sensation. The shingles covered most of the right side of my neck and my lower right jaw, so it wasn’t a small patch of skin either, but it was almost completly painless. The Wiki entry for Neurontin doesn’t mention it being used for the pain for shingles, so I’m wondering if this is something my doctor did on his own, or if it’s well known.
This is really confusing to me. The FDA has approved it only for those aged 50 and above, and without any immune compromising conditions. (That second part probably explains the need for a prescription.) But if it’s safe, and nearly without side effects, why on earth would a healthy person be prevented from getting one solely because they are under age 50?
Because the disease burden (frequency plus degree morbidity due to the disease) is much higher in the older age groups. That’s where the focus was placed when designing the vaccine, and that’s where the evidence of safety and effectiveness is. Biggest bang for the buck, vaccinate those folks at highest risk.
The safety and effectiveness has not been adequately demonstrated in younger folks yet. Also the cost-benefit equation appears to be skewed; spend hundreds of thousands of $$ in vaccination to prevent 1 case? Spend the money on getting other vaccines that are known to be beneficial for that age group instead.
We don’t have unlimited health care dollars. We should put those dollars towards the most effective uses.
Which makes perfect sense as an argument as to whether a National Health Service, or even a private insurance company should cover the cost. But not as a reason to exclude healthy and interested people from paying for it if they desire the peace of mind.
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Most clinical studies are done on young, healthy, males, aren’t they? Is this normally used as a reason to exclude women or middle aged people from using a product? We recognize that the very young, and the very old have special vulnerabilities, and so pediatricians and geriatric specialists make careful decisions about how those groups are treated, but is there always a special trial before they are “allowed” a treatment? Is there any reason to believe that a vaccine which has been demonstrated as safe for 50-year-olds should be unsafe for 40-year-olds?
I know that chicken pox is more dangerous for adults than for children, but if the vaccine works at 50 with no side effects, why the concern? If there is concern re: fertility or birth defects, surly those concerns would be in effect for men of all ages, and for any fertile woman? Why shouldn’t a 45-year-old woman whose had a hysterectomy take it?
I know I’m delving into dark corners at this point. These are not specific questions so much as examples of the source of my confusion. What I am trying to understand is the rationale for the difference between “recommended for anyone in age group X” and “refused to anyone not in age group X.”
When a drug company starts a clinical trial, part of what they need to do is define the patient population. And when they do so, they have to consider both who would benefit from their treatment, and what they’re willing to pay.
Then, it’s a matter of the particular details of the treatment and the trial. In short, there are three phases to FDA clinical trials. Phase one is safety, which will be done on a small number of volunteers (who are frequently young adult males). Basically they will be given the treatment and very carefully monitored by doctors and scientists to determine whether the drug is safe. Phase two is to determine dosing: what is the minimum that gives a detectable benefit, and what is the maximum that does not cause side effects? Finally, phase 3 trials are the very large, randomized, double-blinded trials to determine whether the drug works in the population of interest. They are also very expensive. The size (and thus expense) of the trial is determined by how many patients you need to treat to see a statistically significant effect.
I’ll make up some hypothetical numbers for a shingles vaccine trial. The annual incidence for shingles is around 1 in 100 for adults over age 50. To run the trial, you would give a placebo to 1000 patients, and the actual vaccine to another 1000 patients. One year later, how many patients got shingles? The placebo group had 11 cases, and the treatment group had 2 cases. Statistics ensues and tells us that the treatment was effective. Ta-Da, FDA approval for the shingles vaccine for all adults over age 50!
Now lets say you’re interested in getting approval for the younger age group. Out of an abundance of caution, the FDA wants a new phase 3 trial. (Perhaps you had to crank up the dose so it would be effective in an older population, but this higher dose would cause more frequent side effects in the younger population.) Incidence is much lower, closer to 1 in 1000 for adults 20-50. Already you have to increase the size of your trial to 10,000 patients per group, otherwise you wouldn’t be able to detect any beneficial effect from the vaccine. The expense of the trial is ten times higher.
Furthermore your market research department tells you that nobody is really interested in paying for the vaccine for this age group. Doctors aren’t interested in recommending it, since shingles is rare and not particularly dangerous to this group. Insurers aren’t interested in paying, since they would have to pay for a thousand vaccines to prevent a single cheap-to-treat case of shingles. Very few younger adults are willing to pay out of their own pocket. (I had a fairly mild case of shingles when I was 25. It sucked, I got over it, but even in retrospect I wouldn’t pay $300 to prevent it.)
So the cost of FDA approval for 20-50 year old patients is 10x, but the market is less than 1/10 the size.
Besides, FDA approval and indications are not binding. If you’re 40, if you really want you can find a doctor to give you the shot and pay for it yourself.
Back up a second…is this happening? The only claim here in this thread was that if you don’t meet the guidelines, you need a “note” (a prescription) from your doctor. Since you need a prescription for any vaccine - it’s just a prescription that, in many states, you can get from a pharmacist if you meet the guidelines and don’t even realize you’ve gotten because you never see a prescription pad - I don’t see that as particularly onerous or evidence that anyone’s being excluded from getting it if it’s medically indicated.
Why should it be medically indicated? Because while it’s very low risk, it’s not *no *risk, and we’ve decided that doctors should be overseeing medical procedures and drugs, as they’re trained to evaluate medical risk vs. medical benefits.
Chicken pox is caused by a herpes virus, and can flare into shingles if something causes a compromise of your immune system. Advanced age can do it, or chemo, AIDS, steroid therapy, or even a stressful event like a divorce or job loss.
When I worked at the grocery store, I had an elderly customer who had mysterious chest pain that defied diagnosis for several weeks; she already had a heart condition, so this was what they were looking for. One morning, she woke up with a big stripe of shingles blisters along that dermatome (the area innervated by a spinal nerve). That explained it! A couple days later, she came in with her husband to have coffee with their friends and say hi to us, and wore a nylon windbreaker in 90-degree heat. She said, “I’m 82 years old and had 4 kids. I’m not into that braless look any more!”
I’m really surprised that Medicare doesn’t pay for it. My parents were, too. Anyway, if you don’t think you can afford it, call your county health department. They may give them at a discount, or tell you where you can get them. It doesn’t hurt to ask.
Medicare covers the shingle vaccine under Part D, Prescription Drug coverage. It’s one of those Parts you have to pay extra for, or have supplemental coverage.
Following up on this, I got an automated call from my local grocery’s pharmacy (they said they were checking their records; I can’t recall if I asked them in person about it or called about it) where I tend to get my prescriptions and was told that I could get a shingles vaccine shot under my health plan. It wouldn’t cost me anything, I didn’t need an appointment and I didn’t need a prescription from my doctor.
I think (if I’ve read some news items right) that Obamacare mandates that preventive medical procedures must be provided for free (that is, without any co-pay), and I think that some plans may have gone ahead and started to implement that already. For example, my plan (a major HMO with a Medicare Advantage contract) has been doing this for a while.
I got my shingles shot there a year or so ago, without any co-pay. Just last week I got the dreaded colonoscopy, and that too was done free of any co-pay! And, of course, they do free flu shots for members every year in October.
Last week, my 13 year old son was diagnosed with shingles. Unfortunately he didn’t come to us until after the blisters had popped and started scabbing up. That was when the pain hit him. He had noticed the bumps earlier, but they didn’t hurt, so he thought they were a cluster of mosquito bites and didn’t worry about them.
It was only a small patch on his hip, a circle of about 2 inches in diameter. But it got to the point he couldn’t wear underwear and only loose pants that he could hold the fabric away from the area.
We ended up in the ER due to the pain he was in. They prescribed an antiviral, 800mg of Acyclovir 5 times per day, and sent us home. The Pharmacist mentioned that he’d been seeing a lot of kids getting shingles lately. This was also echoed by our GP on the follow up this past Saturday.
My son had chicken pox before he was old enough to get vaccinated, around 2 years old. Someone mentioned up thread how kids running around with chicken pox act a little vaccinations or boosters. There is some thought that vaccinating kids is leading to a shingles outbreak since there are fewer and fewer kids getting chicken pox due the vaccine.
One thing I read says there is only one company making both the chicken pox vaccine and the shingles vaccine and it is some kind of conspiracy that they get paid twice.
No one prescribed any type of pain meds for my son. Everyone kept telling us to use OTC pain meds like Tylenol or Ibuprofen. My son’s pain is pretty much gone, but he still is on the antivirals for the next few days.
I had thought I was mistaken, and all the signs at my doctor’s asking “are you 70 or 79 years old? Ask about the shingles vaccination” were maybe just badly phrased, hence me saying that it was available to 70-79 years old. But no, I wasn’t wrong - it’s only 70- and 79-year-olds who can get it. Isn’t that unusual?
This is untrue. There are multiple varicella vaccines available.
The relationship between a possible increase in shingles and the increased use of the varicella vaccine is being studied, but at this point, it’s not clear that vaccinating against chicken pox is causing an increase in shingles outbreaks.
I would like to know the answer to this. I had shingles at age 47, it didn’t hurt that bad but it itched like hell. Can I get it again,if I get it again will it cause more pain the second time and should I get vaccinated?
Yes, maybe and yes, talk to your doctor. You don’t meet the general age minimum, but since you’ve had shingles before, your doctor may write you a prescription anyway.
Shingles hit me in my late teens, early twenties. Imho, at 220$ for the vaccine, you’re better off just treating the shingles when it comes out. Iirc, I saw the doctor for two visits and got a week of pills, total cost at 80% coverage was under $100. There is a lot of pain, and i have a relatively high tolerance. On the 1-10 scale, i usually report 2-3 for other people’s 10. I delayed treatment because i got a grease burn at the same time, so i thought it was just a burn. But it didnt go away, and i was unable to sleep on that side of my body (shingles only affects one hemisphere of your body.) the other effect i got was severe scarring after the blisters healed, I’d say maybe 5 square inches.
So, if you can handle the pain and dont mind the scars, its cheaper just to treat it if you get it. If not, the vaccine seems to be a fairly cheap way to avoid it.
I had the vaccine and suffered no apparent ill effect. I believe the current standard in U.S (CDC, FDA, NIH) is persons over 60 regardless of exposure. There are some limited contraindications. Shingles vaccine: Should I get it? - Mayo Clinic Mine was free from the V.A.
Reanimating this zombie to say: I’ve finally got an answer to this question.
It turns out, that the Shingles vaccine is specifically approved only for only one dose per lifetime. It also shows a slow drop-off of effectiveness over two decades. So these doctors are trying to do the right thing by saving the dose and the most effective years for the time of life when Shingles is both most likely, and most severe.
I wish I could give you a more acceptable cite, but, I know because my doctor told me.
