Herpes Zoster in Older Adults
In the past, adults received an immunity boost from contact with children infected with chickenpox or VZV. After the VZV vaccine (Varivax, Merck & Co, Whitehouse Station, NJ) became widely used in the pediatric population, a dramatic decline in chickenpox resulted; thus, fewer opportunities for adults to receive that immunity boost occur. In 2006, Merck & Co Whitehouse Station, NJ, marketed the first HZ vaccine, Zostavax, for adults. Based on the Shingles Prevention Study, Zostavax has been found to reduce the incidence of HZ by 51% and the incidence of PHN by 67%. The Center for Disease Control and Prevention recommends a 1-time immunization for adults 60 years and older for whom the vaccine is not contraindicated. Contraindications include severe immunocompromising health conditions such as leukemia or human immunodeficiency virus; medical treatments such as chemotherapy, radiation treatments, or medicines such as high-dose steroids or rheumatoid arthritis medications; or allergies to gelatin or neomycin.
Patients must decide the benefits versus the burden of immunization. NPs need to be informed and ready to answer their patients' questions about the benefits and burden. The benefits include the reduced chance of having HZ and PHN. The burden or risk is localized erythema, swelling, and pain at the injection site. Patients should be encouraged to report any of these reactions to the NP and the Zostavax Web site. Another burden is the cost because it can cost $200 to $300 without insurance. However, the cost may be minor in comparison to the cost of a person's diminished quality of life when dealing with months or years of PHN and the cost of medications for pain relief.
Phase 3: Prevention
In the past, adults received an immunity boost from contact with children infected with chickenpox or VZV. After the VZV vaccine (Varivax, Merck & Co, Whitehouse Station, NJ) became widely used in the pediatric population, a dramatic decline in chickenpox resulted; thus, fewer opportunities for adults to receive that immunity boost occur. In 2006, Merck & Co Whitehouse Station, NJ, marketed the first HZ vaccine, Zostavax, for adults. Based on the Shingles Prevention Study, Zostavax has been found to reduce the incidence of HZ by 51% and the incidence of PHN by 67%. The Center for Disease Control and Prevention recommends a 1-time immunization for adults 60 years and older for whom the vaccine is not contraindicated. Contraindications include severe immunocompromising health conditions such as leukemia or human immunodeficiency virus; medical treatments such as chemotherapy, radiation treatments, or medicines such as high-dose steroids or rheumatoid arthritis medications; or allergies to gelatin or neomycin.
Patients must decide the benefits versus the burden of immunization. NPs need to be informed and ready to answer their patients' questions about the benefits and burden. The benefits include the reduced chance of having HZ and PHN. The burden or risk is localized erythema, swelling, and pain at the injection site. Patients should be encouraged to report any of these reactions to the NP and the Zostavax Web site. Another burden is the cost because it can cost $200 to $300 without insurance. However, the cost may be minor in comparison to the cost of a person's diminished quality of life when dealing with months or years of PHN and the cost of medications for pain relief.
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