INDIAN RIVER COUNTY — On Valentine’s Day, 1995, a then-68-year-old island resident was finishing up a game of doubles tennis when his leg began to ache. When the last volley ended, he could barely make it off the courts. Searing pain shot from his foot to his thigh. Blisters erupted and he went to his doctor, but the doctor was mystified. Days later his neighbor, a retired doctor, made the diagnosis – shingles.
The shingles vaccine came too late to have prevented his attack.
Developed in 2006 and manufactured by Merck, the vaccine prevents shingles in half the people vaccinated. For more than 60 percent of the rest, it minimizes discomfort during the outbreak. And for 67 percent, it prevents postherpetic neuralgia, the painful syndrome the tennis player has suffered from for 17 years.
Last month, after a heated battle with the Florida Medical Association, a physicians’ lobby, the state made it easier for people to get that vaccine.
It implemented a new law allowing pharmacies to administer the shingles vaccine, as well as the vaccine for pneumonia.
As part of the legislature’s compromise with the 20,000-member FMA, the shingles vaccine requires a prescription; the pneumonia vaccine does not.
And even though pharmacists have been giving flu shots for years, they are now required to get continuing education – supplied by the FMA.
Never mind that the legislature was a little late to the game – pharmacies have been vaccinating for shingles in nearly every other state in the years since it was developed.
There’s also the matter of convenience.
One study found older people visit their pharmacy on average once a month.
When pharmacies began offering flu shots in the 1990s, the vaccination rate shot up.
“I think everyone should get the shingles vaccine if they’re over 60,” says geriatrician Garrick Kantzler.
He is currently treating the patient with postherpetic neuralgia.
Apart from one case of encephalitis, Kantzler says the Vero great-grandfather, now 85, has the worst case of shingles he’s ever seen.
“The biggest problem I see is postherpetic neuralgia,” he says. “Almost everyone with shingles has pain but most of the time it’s not severe and goes away in a month. But pain that last years can be debilitating.”
“I’m a big advocate of the vaccine,” says Dr. Gerald Pierone, an infectious disease specialist with a concierge practice in Vero. “You see one bad case of shingles and you’re convinced.”
At least one local doctor who also advocates vaccination for shingles feels that it is best delivered at the office of a patient’s physician.
That doctor, geriatrician Dennis Saver, is part of a primary care clinic that has its own pharmacy and lab.
“We generally encourage our patients to get their care here as opposed to hither and yon,” said Saver.
“People should be attached to a primary care doctor who knows their history, centralizes their care and keeps track of things,” says Saver, calling the clinic’s concept a “patient-centered medical home.”
“We want to keep close track of the all the health care our patients are getting.”
Pressed, Saver agrees that a doctor who wrote a prescription for a vaccine would normally keep that in the patient’s file, regardless of where it was administered.
Asked if there were other negative consequences of getting vaccinated at a pharmacy, he says, “None that are major.”
“In the big picture, it’s a matter of people developing habits. I don’t think that for most people, getting their immunizations at the drug store is a good habit. But if the option is you don’t get it at all, get it at the drug store.”
The legislature’s move likely means many more people will avoid the suffering that shingles can bring on, and in particular, the postherpetic neuralgia that can be debilitating for months if not decades.
Locally, Walgreen’s and Publix are among those already providing the vaccine.
CVS is expected to follow suit.
“Not everyone has the special freezer to store them in,” says Mike Gregory, a pharmacist at the Publix on Miracle Mile. He says within two months, all Publix stores should be equipped for the vaccine.
Publix charges $215 for the vaccine. Typically, there is very little wait if any.
Since its development, the shingles vaccine has been approved for ages 60 and over. Last year, the FDA approved the vaccine for people 50 to 59, though insurers have been reluctant to cover it in that age group.
“When it first came out, people were wondering, ‘Do I really want to do this?’ You can treat shingles with an anti-viral if you catch it in the first three days,” says Pierone. “Then three months later, a patient of mine was up north and he had a really bad case of shingles that involved the face and eye. It wasn’t really managed well and he ended up with postherpetic neuralgia. It was a year of misery for him. After that, I said yes, even though it’s rare to get a really bad case.”
Pharmacist Gregory says it is those bad cases that are driving patients in as word of the vaccine is spreading by word of mouth.
“People are a little trepidatious about the vaccine and its cost but as soon as they get to know someone who’s had shingles, they come right on in.”
Once a person has had chicken pox – and nearly everyone past middle age has – the chances of developing shingles roughly doubles with every decade after 50 years of age.
Today, children are vaccinated against chicken pox, but nearly all adults middle age and older have been exposed, practitioners say.
“With our children, we all tried to gather them together if one of them got chicken pox, because we all wanted to get it over with at the same time,” says Lynn Wandell, adult-health supervisor at the Indian River County Health Department. “We all thought chicken pox was benign. Years later, we realize it’s not.”
Wandell says the clinic, which offers the vaccine, has seen four or five cases of shingles in the past six months. “They only know it when they see the rash. Usually people will say, ‘Something was really hurting on the back of my neck,’ or wherever, and all of a sudden they felt a little blister, then another, then another. It comes in a line and it’s pretty painful.”
While herpes zoster, the medical name for shingles, is not as contagious as other types of herpes, it can spread to the eye, a serious complication known as ocular herpes.
It can also travel down the nose, down the throat to the esophagus and down into the stomach.
“It can have some very severe side effects, not being able to eat or to swallow.”
It can also lead to pneumonia, hearing problems and even death, says Wandell.
Wandell says patients are asked if there are allergic to eggs, gelatin or neomycin, any of which would preclude getting the vaccine. It is typically not prescribed for people with a compromised immune system, or those taking cortisone for rheumatoid arthritis, Kantzler says.
Kantzler’s 85-year-old patient is now on methadone to control his pain. So far it is helping. But he rarely has total relief. The best he can hope for is numbness rather than pain, but that can be debilitating too, especially at his age, 85.
“You’ve got to be careful or you’ll Fall,” the patient says. “You don’t get any feedback from your foot if it’s numb.”
“I’ve given up golf, tennis and sex,” says the patient, still jocular despite the pain.
His health problems caused him to miss a grandchild’s wedding. He’s fending for himself while his wife is away.
“I can fix my meals, but she feels bad about that. She worries about me,” he says. “My wife always drives now. I tell her that’s OK. Now she doesn’t have to tell me where to turn.”