Should You Get A Shingles Vaccine?

Folks,

I sent the following letter (below) to the editor of the American Family Physician Journal. I wrote the letter after reading an article about the shingles vaccine. “Do I need the shingles vaccine,” is one of the most common questions I receive in my practice. I hope this letter will help you decide on whether to get the shingles vaccine. I have reprinted the letter that I sent to the editor. This letter was rejected by the American Family Physician Journal.

Original article: Prevention of Herpes Zoster in Older Adults by Jared Kocher published on November 1, 2013

The author wanted to answer the question, “In older adults, is vaccination against herpes zoster effective and safe? The author summarized the Cochrane Review and stated that, “The herpes zoster (shingles) vaccine has demonstrated effectiveness in preventing shingles in older adults.”

However, reading the section titled Practice Pointers presented a different picture. In this section, the author states that, over a median surveillance period of 3.12 years, with over 52,000 participants, there was a 51% relative risk reduction in confirmed cases of herpes zoster in those that received the vaccine. Furthermore, the author stated that among those aged 60-69, the number needed to treat to prevent one case of shingles was 50. Among those 70 years and older, the number needed to treat was 100.

These numbers show that, in those aged 60-69, the shingles vaccine was ineffective for 98% (forty-nine out of fifty) of those studied. For those aged 70 and older, the vaccine was 99% ineffective, since 99 out of 100 received no benefit.

I am incredulous that anyone looking at this data could proclaim that the shingles vaccine was effective. In fact, it wasn’t. According to this data, the shingles vaccine was a 98-99% failure. Assuming the cost of the vaccine is $200 (a generous assumption), we would have to vaccinate 50 subjects aged 60-69 years to prevent two cases of shingles at a cost of $10,000 per case. For those over 70 years, 100 patients need to be vaccinated to prevent one case of shingles at a cost of $20,000. Clearly, this vaccine is not cost effective in these tough economic times.

Finally, the author summarized the adverse effect risk of the shingles vaccine. The number needed to harm from the vaccine was 2.8. That means for every 2.8 vaccines given, one patient was harmed. Furthermore, for every one hundred subjects vaccinated, one had a severe adverse reaction such as rash, fever, or hospitalization.

At the end of the article, the author states, “Overall, the herpes zoster vaccine is safe, effective, and well tolerated…” I can’t understand where that statement came from. The numbers don’t lie. The concluding statement should have read, ”Overall, the herpes zoster (Shingles) vaccine is neither safe, effective or well tolerated.”

David Brownstein, M.D.
5821 W. Maple Rd. Ste. 192
West Bloomfield, MI 48323

ac******@ho*****.com