A frightening TV ad campaign appeared recently, paid for by Merck, Sharp & Dohme, about people over 60 who had chicken pox as children and could, decades later, suffer from herpes zoster (shingles), a neurological condition involving a lot of pain. Apparently, the virus can remain “asleep” in the nerves and suddenly wake up and cause severe pain. It was sponsored by the company that makes a vaccination against the virus. I fit the description of a person who should get the shot, as I am 62 and had chicken pox as a child in the US. I would like to know if the shot is necessary. If so, is it safe? Are there side effects? Where does one get the shot? How much does it cost? If it’s important to prevent illness for months or years, wouldn’t it ultimately save the Health Ministry to pay for it? – T.S., Tiberias
Judy Siegel-Itzkovich replies:
Various physicians whom I contacted, experts in neurology, vaccinations, pharmacology and family practice, had differing views on the vaccination. Some claimed the advertisement was “scary and exaggerated,” and that getting the shot was not mandatory.
Prof. Mordechai Ravid, a veteran internal medicine specialist who is director-general of the Ma’ayanei Hayeshua Hospital in Bnei Brak, strongly criticized MSD’s TV ads, saying herpes zoster affects only eight people per 1,000, causing pain along the nerves and in the skin. In most patients, he said, it is a one-time condition that is liable to return in people with weak immune systems due to blood cancers, AIDS and lupus erythematosus. It is rarely so painful that the patient goes to the doctor, he said; the pain and red blisters on the skin usually pass in a week to 10 days.
In a third of those with herpes zoster, pain or sensitivity can go on for several months. Only very rarely, said Ravid, will it cause harm to the central nervous system.
Healthy people do not need the vaccination; the vaccine should be supplied free to those with serious medical problems who need it, he suggested.
Dr. Eyal Schwartzberg, the Health Ministry’s chief pharmacist, said he approved the advertising campaign after the wording was changed somewhat. The ad was not allowed to name the commercial vaccine, which is called Zostavax. “We allowed it to appear because the public has the right to know. The vaccine, which costs NIS 500 to NIS 800 per person, is not included in the basket of health services, but we recommend it,” said Schwartzberg.
Asked why the ministry or the public health funds have not purchased enough vaccine in bulk to lower the price and then sell it to people over 60 who want to buy it, Schwartzberg did not have an answer.
Prof. Tamir Ben-Hur, chairman of the neurology department and director of the division of clinical neurosciences at Hadassah University Medical Center in Jerusalem’s Ein Kerem, commented:
Herpes zoster is caused by reactivation of the virus in the peripheral nervous system (the same virus that causes chicken pox in children). It is prevalent especially in the aging population, probably due to natural decline in the immune system.
The most common complication of herpes zoster is post-herpetic neuralgia, potentially an extremely painful condition. Not infrequently, there are various neurological complications that cause neurologic disabilities.
Large population studies have shown that the vaccine, produced by MSD, is quite effective in preventing reactivation and in lowering the incidence of post-herpetic neuralgia. Its protective effect is only partial, but it has been proven significant.
These studies have led to the approval of the vaccine for the general elderly population – initially to people over 70, then the age was lowered to 60. More recently, it was allowed in the US for people above 50, as 15 percent of the cases of painful shingles there are in people aged 50 to 60. Calculations of cost-effectiveness have suggested the recommended age should be further lowered.
A professional task force appointed by the Health Ministry in Jerusalem studied the issue and recommended following other countries in making the vaccine available on the market, but said people over 60 were the target ages. I was a member of this task force. This is a medical recommendation; the issue of being added to the subsidized health basket is a financial one. As a result, it is not covered by the health funds, so the burden of purchase is on the individual.
Should everyone hurry and buy the vaccine? I think there is no need to rush; everyone should make his own decision after speaking to their personal physician and considering the cost. Unfortunately, the media is being used cynically by a drug company, using a scary commercial to sell its product.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to firstname.lastname@example.org, giving your initials, age and place of residence.