Louise Abate first noticed an itchy tingle near her hairline. The pain started a day or two later as a blistering rash swept down from her scalp onto her forehead. “My eye was so swollen I couldn’t open it,” she said.
Shingles: Abate, 76, a retired casino supervisor in Rio Rancho, N.M., had the disease twice before, in her 60s, but the episode three years ago hit particularly hard.
Long after the rash healed, which took about three weeks, she suffered the complication called postherpetic neuralgia – lingering nerve pain that can last for months or even, as in her case, years. “I get up every day, and it’s there,” she said. “I go to sleep, and it’s there.”
She had heard something about a shingles vaccine, but “I really didn’t pay attention,” Abate said. And she is hardly unusual.
It is a continuing and vexing public-health problem: People once vigilant about vaccinating their children are not nearly as careful about protecting themselves as they age, even though diseases such as influenza, pneumonia and shingles (also known as herpes zoster) are particularly dangerous for older people.
“Trying to prevent these common and often debilitating conditions is incredibly important for older adults,” said Dr. Carolyn Bridges, associate director for adult immunization at the Centers for Disease Control and Prevention. Yet, in the CDC’s 2014 and 2015 reports on vaccination coverage, she said, “we really didn’t see much change.”
Most Americans older than 65 get an annual flu shot, but the proportion actually declined a few percentage points last season to about 63 per cent. The CDC estimates that of the 226,000 people hospitalized for flu in an average year, 50 per cent to 70 per cent are older than 65; so are the great majority of those who die from it. “Older adults take the brunt,” Bridges said.
Similarly, in 2014, about 61 per cent of older adults had received one or both of the two pneumococcal vaccines, which protect against pneumococcal infections that can lead to pneumonia and meningitis. That represented no improvement, leaving millions of older people still vulnerable.
About 58 per cent of older people had been vaccinated against tetanus during the past 10 years, but only 14 per cent had received the recommended dose of the Tdap vaccine against tetanus, diphtheria and whooping cough. It is especially important for grandparents and others who have contact with infants too young to be vaccinated.
And elders have been particularly slow to take advantage of the shingles vaccine. The U.S. Food and Drug Administration approved it a decade ago and the CDC recommends it for those older than 60, including those who’ve already had shingles.
Coverage has climbed steadily, but in 2014 had still reached only 31 per cent of those older than 65. As with nearly all of these vaccines, older whites were more likely to have been vaccinated than blacks, Hispanics or Asians.
Why these missed opportunities?
“Vaccines are less likely to be routinely incorporated in adult medical practice,” Bridges said. “Every time a child comes in, a pediatrician makes sure they’re up-to-date.”
Older adults often have medical issues that take precedence during brief office visits. They also see specialists who are more focused on cardiology or oncology than on flu and shingles.
Seniors and their caregivers should request vaccinations; the CDC publishes guidelines and a quiz that explain which ones are recommended. Zostavax, the current shingles vaccine, reduces the risk of the disease in adults older than 60 by half, and the incidence of postherpetic neuralgia by two-thirds.
(Quick primer: Shingles results from the same virus that causes chickenpox, which nearly all older Americans have had. The virus typically remains dormant for decades, but the odds of its reactivation rise steeply after the age of 50 as the immune system weakens. The lifetime risk of shingles is one in three, rising to one in two for those older than 85.)
The vaccine’s underuse can be blamed, in part, on supply shortages in its early years until about 2012. The manufacturer, Merck, and the CDC did not increase media campaigns until vaccine supplies were sufficient; such campaigns had just started when Abate became ill. It is not surprising that she was only vaguely aware of Zostavax.
(She is starting to feel better, but still needs a sedative to sleep and Zoloft for the depression that chronic pain can produce. “It’s been a long road,” she said. Now vaccinated against a shingles recurrence, she’s urging her children to get the shot.)
They do not have a great track record. Public health leaders do not want older adults waiting to see what the FDA does. One million Americans will get shingles in the coming year; the CDC wants seniors to get vaccinated now.
Bridges endorsed a pragmatic but less-than-festive holiday gift idea I suggested: A card with a promise to take an older family member to get vaccinated and to pay any charge or co-pay.
Bridges suggested another gift: That younger family members get flu shots themselves. Since more than a third of older adults do not, families can at least avoid infecting their senior members at holiday gatherings.
“Give them the shingles vaccine as a gift,” Bridges said. “But don’t give them the flu.”