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Politics & Government

Vaccine Can Prevent Shingles But Few Get It

It is available at several pharmacies and doctors' offices in the region.

A vaccine that’s been on the market for five years this May can prevent half of the nation’s one million cases of shingles each year. Yet, only about 10 percent of adults who could benefit have availed themselves. 

Why?

Too few know it exists. Many who do can’t afford it. And even if they can, supplies are scarce.

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Merck and Co., the only manufacturer of the vaccine (brand name Zostavax), is several months behind in filling orders and cannot predict when its stock will exceed demand.

“We‘re making vaccine all the time. It‘s a long process,” said Dr. Eddy Bresnitz, Merck‘s medical affairs director. Also, he noted, Merck makes two other vaccines from the same bulk virus, both for childhood vaccines against chickenpox, that have been the company‘s priority.

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Shingles is a common, painful, blistering rash caused by the same virus that causes chickenpox.  More than 30 percent of adults who had chickenpox as a child will get shingles over the course of a lifetime, according to Dr. Stephanie Bialek, a medical epidemiologist with the U.S. Centers for Disease Control and Prevention in Atlanta.

The long-dormant virus, often resting at the base of a sensory nerve, reawakens with a vengeance.  If the rash spreads to the eyes, vision loss can occur. An estimated 20 percent suffer prolonged pain and nerve damage, a condition called post-herpetic neuralgia, that can last months or years after the rash has resolved.

The vaccine, licensed in May 2006, is recommended for anyone age 60 and older unless they have a weak immune system, the HIV virus, leukemia, or allegies to any components of the vaccine.  Even someone who has recovered from a bout of shingles can benefit from the vaccine’s protection from another bout.

Locally, it is available at few locations in the Nazareth area, but is available at the Bushkill Family Practice in Wind Gap (for existing patience only) and the Bethlehem Health Bureau. Merck’s website offers help using a zip code. It pays to call, however, because some sites only offer to current patients and some are out of supply. 

A recent study out of California shows the vaccine to be even more effective than originally thought, preventing shingles in 55 percent, or 4 percentage points higher than Merck’s original findings.

Federal health officials would like to see 30 percent or more of the 60+ population vaccinated by the year 2020.  That’s three times the current rate of immunization, with obstacles to overcome:

Lack of awareness -- A CDC study conducted in 2007, a year after Zostavax became available, showed a mere 1.9 percent of the targeted population had received the vaccine. Researchers owed 72.9 percent to a lack of awareness that such a vaccine existed. 

Physician resistance --  Doctors have been slow to promote the relatively safe and effective vaccine because of storage and payment reasons.  First, Zostavax is covered under Medicare Part D plans, not Part B, like the flu and pneumonia vaccines, so doctors cannot receive direct payment for administering it. Pharmacists who give vaccines are paid directly, so doctors may be more inclined to refer their patients to pharmacies where they can get the shot. Also, because the vaccine contains a live virus, it must be kept frozen until used.  

Cost -- Senior citizens ages 65 and older need to check with their Part D insurance carrier to determine which pharmacies and doctors to go to for the best coverage and how much they have to pay out-of-pocket.   Adults who do not have Part D or do not yet qualify for Medicare might pay the full price of Zostavax, which can be $200. 

Production and supply -- Almost from the start, supplies of Zostavax have fallen behind on orders because of the complexity in making it and the company’s priority in producing the two other vaccines that contain the virus.

One local carrier of the vaccine is Primary Care Associates of the Lehigh Valley, a busy primary care practice in Allentown.  Patients of that practice can obtain a prescription for Zostavax to be filled at a pharmacy and administered there or to be brought immediately to the office for administration.  Primary Care Associates does not stock the vaccine because of storage and reimbursement issues.

West End Medical, a primary care practice in Cetronia with many older patients, stores and administers the vaccine for its patients but is currently out of stock, expecting the next shipment in July. It takes a little longer to get paid, an office supervisor said, comparing Zostavax reimbursement with flu shots.

Merck representatives lobbied for Zostavax to be included in Part B coverage, Bresnitz said, but lost. Instead, Merck and some state health departments are offering limited numbers of Zostavax vaccine free to those who cannot afford it or who live in regions covered by public health. 

A recent offering of 350 doses of Zostavax by the Allentown Health Bureau was well received, according to Health Director Vicky Kistler, with nearly 300 administered to city residents within days of the announcement. Bethlehem Health Bureau provided 50 doses for free last year but now charges $160 and has a waiting list.

Although a Minnesota senator was so upset by the shortage of shingles vaccine that she asked the U.S. Food and Drug Administration to “take action,“ Merck’s Bresnitz said he’s not sure what the FDA or anyone could do to speed up the process. Merck is investing $1 billion in a new manufacturing plant in North Carolina, he said, ramping up bulk virus production at West Point, and expanding production at its plants in France and New Orleans.

Bresnitz could not predict when the company will have a comfortable enough reserve to absorb the ebb and flow of demand, but he remains optimistic.

“Will we make the (2020 federal health) goal of 30 percent?,” he asked, repeating the question. “I think we can.” 

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