Shingles, the most common neurological disease in the country?
August 2009
Annually, 1.1 million Americans contract shingles, more than half of whom are over age 60.1,2 Shingles is caused by varicella zoster virus, the same virus responsible for chickenpox. Approximately 90 percent of Americans over the age of 15 have had chickenpox; two out of ten people will develop shingles during their lifetime.3
Varicella zoster virus remains in nerve cells after the initial infection that causes chickenpox and can cause shingles if the virus reactivates. Shingles cannot be transmitted by person-to-person contact; however, a person who has never had chickenpox or the chickenpox vaccine may contract chickenpox from someone with shingles, though this is extremely rare.
Symptoms & Treatment
- The first sign of shingles is localized burning, tingling, numbness or itching on the face or along one side of the body.4
- After several days, a rash of fluid-filled blisters similar to chickenpox appears where the initial symptoms presented.4 The main difference between chickenpox and shingles is that shingles generally erupts in a band on one side of the body, rather than all over your body.3
- One in five persons who get shingles will experience post-herpetic neuralgia (PHN), severe pain that can continue for months or even years after the rash clears up.5,6
- Other complications include eye involvement resulting in vision loss, bacterial superinfection, and facial scarring.6
The severity, duration and complications of shingles can be significantly reduced by treatment with antiviral drugs within 72 hours of rash onset.6 Unfortunately, these treatments do not completely alleviate pain or prevent PHN and may be poorly tolerated.6
The Economic Impact: Why Employers Should Care
The direct and indirect costs of shingles can be substantial for employers. Shingles necessitates 2.1 million doctor visits per year1 and healthcare utilization for zoster and PHN increases substantially with age.6 Furthermore, indirect costs result from losses in work time caused by temporary or permanent disability.
- Among patients with acute episodes of zoster, average expenditures (in 2006 dollars) ranged from
- $112 - $287 per outpatient care visit;
- $73 - $180 per antiviral treatment;
- $3,221 - $7,206 per hospitalization;6 and
- $566 - $1,914 per episode of PHN.7
- Among the subset of patients with PHN persisting from 30 days to 12 months, annualized healthcare costs ranged from $2,159 to $5,387.6
- The persistent pain associated with shingles costs employers:
- approximately $4,917 per patient8 and
- an average of 129 hours of lost worker productivity per outbreak.6
Prevention: The Shingles Vaccine
In 2006, the Food and Drug Administration approved a zoster vaccine (Zostavax) for use in people ages 60 and older who have had chickenpox. Vaccine administration to older adults reduced the expected number of shingles cases by one-half. Consequently, the Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of all persons aged ≥60 years with 1 dose of vaccine.6 Certain individuals should not receive the vaccine, including those who have a weakened immune system, so consulting a physician is recommended.5
What Employers Can Do
The Census Bureau estimates there are 50.6 million Americans age 60 years or older, yet only 1 million doses of Zostavax were distributed the first year the vaccine was on the market.9 At a price of approximately $150 per dose, employers should promote the vaccine to their older employees, many of whom are at risk of developing shingles. Instating preventive vaccination for shingles among eligible employees may result in future health care cost savings.
Additional information about the shingle's vaccine is available at Centers for Disease Control and Prevention, Shingles Vaccine Fact Sheet. For information such as publications, news, research literature, and ongoing clinical trials, please visit National Institute of Neurological Disorders and Stroke (NINDS) Shingles Information Page.
References
- Soni A, Hill S. Average annual health care use and expenses for shingles among the U.S. civilian noninstitionalized population, 2003-2005. Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, December 2007. Available at: http://www.meps.ahrq.gov/mepsweb/data_files/publications/st194/stat194.pdf. Accessed July 27, 2009.
- Oxman MN, Levin MJ, Johnson GR, al e. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. New England Journal of Medicine. 2005;352(22):2271-2284.
- Novartis Pharmaceuticals Corporation. The facts about shingles. Available at: http://www.shingles.com/info/about/what/index.jsp?usertrack.filter_applied=true&NovaId=3350119560815055638. Accessed July 27, 2009.
- National Institute of Neurological Disorders and Stroke. NINDS shingles information page. Available at: http://www.ninds.nih.gov/disorders/shingles/shingles.htm. Accessed July 27, 2009.
- Centers for Disease Control and Prevention. Shingles vaccine: what you need to know. Available at: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-shingles.pdf. Accessed July 27, 2009.
- Harpaz R, Ortega-Sanchez I, Seward J. Prevention of herpes zoster: recommendations of the advisory committee on immunization practices (ACIP). Centers for Disease Control and Prevention, MMWR, May, 15, 2008. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e0515a1.htm. Accessed July 27, 2009.
- Dworkin RH, White R, O'Connor AB, Baser O, Hawkins K. Healthcare costs of acute and chronic pain associated with a diagnosis of herpes zoster. J Am Geriatr Soc. 2007;55:1168--75.
- Dworkin R, White R, O'Connor AB, et al. Health care expenditure burden of persisting herpes zoster pain. Pain Medicine. 2008;9(3):348-353.
- Centers for Disease Control and Prevention. CDC seeks to protect older adults with shingles vaccine message. Available at: http://www.cdc.gov/vaccines/vpd-vac/shingles/downloads/shingles-vac-msg-2008.pdf. Accessed July 27, 2009.
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