One of the most exciting developments in the neuropathic pain field is the development of a vaccine for Varicella Zoster. This vaccine essentially prevents the development of shingles by boosting the body's immune system to the Zoster virus. The information for this article is from the New England Journal of Medicine article "A Vaccine to Prevent Herpes Zoster and Postherpetic Neuralgia in Older Adults" N Engl J Med 352:22 pp. 2271-2284. The purpose of this article (like the rest of this site) is to put these findings in perspective and in layman terms.

The shingles represents a reoccurence of the herpes zoster virus or chicken pox virus which was not completely eradicated during childhood. The reoccurence rate increases as one gets older. Therefore, in this study, persons older than 60 were randomized to receive either the varicella zoster vaccine (VZV) or placebo. Subjects were followed an average of 3.12 years.

The placebo group gives insight into the natural history of the shingles. The chance of getting shingles was found to be about 1.1% each year. Those over 70 were only about 10% more likely to get shingles than those between 60 and 70. A total of 642 subjects in the placebo group got the shingles. Unlike traditional care, all of these patients were instructed what to look for in case they got a rash. They were quickly seen and started on famvir. Because of this prompt treatment, the incidence of post-herpetic neuralgia was extremely low. Post-herpetic neuralgia is typically defined as pain beyond 90 days which was only 80 of the initial 642 patients or about 12%. This is much less than one would expect and probably represents early treatment with Famvir. Of note, only 33 patients had pain 6 months after the initial outbreak so the effect of the famvir appears to be to prevent 95% of long term post-herpetic neuralgia.

The vaccine treated group did even better than the placebo group. The chance of getting the shingles was less than 1/2 of the placebo group or about 1 patient per every 200 vaccinated individuals. The vaccine appears to be more effective in the 60-69 year old group (65% effective) versus those over the age of 70 (55% effective). Just as impressive, of the 315 patients in the vaccine group who developed the shingles, only 27 (9%) developed post-herpetic neuralgia and only 9 (3%) had long term (> 6 months) of post-herpetic neuralgia. Therefore, not only did the vaccine prevent a high percentage of cases, those who did get the shingles were less likely to develop painful complications.