Should Shingles Vaccine Be Recommended for Everyone?

The introduction of a routine childhood dose of varicella vaccine (chickenpox) in the United States in 1996 led to an approximate 90% decline in varicella incidence.

However, because of continued outbreaks, a second childhood dose of varicella vaccine was introduced in 2006.

Chickenpox is a very contagious disease, causing a blister-like rash, itching, tiredness, and fever. Chickenpox used to be very common in the United States. Each year, chickenpox caused about 4 million cases, about 10,600 hospitalizations and 100 to 150 deaths.

Some people who are vaccinated against chickenpox may still get the disease.

A new study published by JAMA Dermatology uses a nationwide database of emergency department (ED) visits to examine herpes zoster (HZ, shingles)-related ED utilization and costs.

HZ can develop in anyone who has had varicella (chickenpox) or gotten the varicella vaccine, although the risk is lower in those who were vaccinated.

A vaccine for HZ has been available in the United States since 2006 and it can reduce the likelihood of developing HZ in adults 60 and older, for whom vaccination is recommended.

Arash Mostaghimi, M.D., M.P.A., M.P.H., of Harvard Medical School and Brigham and Women's Hospital, Boston, and co-authors report that between 2006 and 2013, the percentage of HZ-related ED visits increased by patients 20 to 59 years old.

But, HZ-related ED visits decreased for patients ages 18 to 19 and for patients 60 and older.

For all three age groups, the overall average cost for HZ-related ED visits increased from $763 to $1,262, according to the research results.

"Our study found despite decreased utilization in patients aged less than 20 years and 60 years or older, we found increased total adjusted charges in these populations. Our findings suggest that vaccination may be associated with a reduction of ED utilization.”

"This study, researchers caution, doesn't allow them to directly link the change in utilization to vaccination, and that further research is necessary to identify the drivers of increased costs."

Zostavax is the only shingles vaccine currently approved for use in the United States. This vaccine reduces the risk of developing shingles by 51% and post-herpetic neuralgia (PHN) by 67%. It is administered subcutaneously as a single dose, and can be given in a doctor’s office or pharmacy.

The cost of Zostavax can be researched at this link. 

These researchers did not disclose any conflicts of interest: Erica D. Dommasch, MD;  Cara J. Joyce, PhD;  Arash Mostaghimi, MD, MPA, MPH.