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News of the Day ... In Perspective

10/28/2006

Federal advisory committee recommends shingles vaccine

The Advisory Committee on Immunization Practices (ACIP) has recommended that Americans 60 and older receive the recently approved Merck vaccine against herpes zoster (shingles).

Zostavax is described as a “souped-up version” of Merck’s chickenpox vaccine for children, containing a live virus that is 14 times more potent.

In a study of 38,000 persons, half of whom received the vaccine and half of whom received placebo, “people who got the shot developed shingles at only half the rate of those who got the fake vaccine,” reported the Associated Press (Arizona Daily Star 10/26/06).

The actual number of shingles cases was 315 (1.6%) for the treatment group and 642 (3.3%) for the placebo group (Oxman MN et al. N Engl J Med 2005;352:2271-2284).

The price of $150 is expected to hurt demand for the vaccine. Medicare is supposed to start paying for the vaccine in January, but it will be treated as a prescription drug, and Medicare will not pay physicians an administration fee. Pharmacists are being urged to add Zostavax to the menu of vaccines they administer to adults (San Francisco Chronicle 9/26/06).

Joel M. Kauffman, Ph.D., reviewed the adverse effects substudy performed on one-sixth of the Zostavax study subjects. Extrapolating the results to the entire study population, he noted that the treatment group had 132 more cases of serious adverse events, and 4,677 more cases of one or more adverse events than the placebo group.

Recalling early reports of successful treatment of symptomatic shingles with intravenous Vitamin C, Kauffman writes: “Since intravenous sodium ascorbate is known to be quite safe, treating only those patients who develop clinical manifestations of shingles would seem to be a far better approach, both medically and financially, than mass vaccination with a large number of adverse effects, if this treatment is indeed as effective as has been stated” (Kauffman JM. J Am Phys Surg 2005:10:117).

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