Q: I am a soon-to-be 63-year-old female. My primary-care physician recently suggested I get a shingles vaccine. I have some peripheral neuropathy in my feet and have had Raynaud's disease since I was a young woman. I am also pre-diabetic but seem to have that under control.

I have done some research on the vaccine; but I am not sure if I want to get it or not.

ACould you give me some advice/information on this matter? — Mary Lou

The vaccine was approved in May of 2006, and is now recommended for all adults over 60. Let's first talk about shingles, since some people may not know about this disease. The illness is caused by varicella, the same virus that causes chickenpox. Shingles occurs when the chickenpox virus, "sleeping" in nerve cells of the people who have had chickenpox before, "wakes up." This happens more in older people, or others with health problems and weak immune systems. The vaccine, Zostavax, is actually a boosted dose of the chickenpox vaccine currently given to children. Shingles causes a rash with blisters that usually lasts for two to four weeks. The pain associated with the blisters can be quite intense. Once this initial phase is over, nerve pain called postherpetic neuralgia (this just means "pain after herpes" in Latin; the varicella virus belongs to the herpes group) can set in. This pain lasts anywhere from 30 days to months or even years. It can be so severe in some people that it disrupts their lives. It has a burning quality

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to it and it is rather difficult to control with medications. If you have ever experienced a cold sore on your lips, the unpleasant pain you felt with the sore is the type of pain people with shingles feel, except that the shingles pain is more severe.

Pain after shingles is more common in people older than 60. It occurs in less than 10 percent of people younger than 60 after a bout of shingles, but in more than 40 percent of people older than 60. Without vaccination, about 20 percent of people who have had chickenpox eventually will get shingles. A person who lives to be 85 has a 50 percent chance of getting shingles. In a clinical trial involving thousands of adults 60 years old or older, the vaccine prevented shingles in about half (51 percent) of the people and post-shingles pain in 67 percent of the study participants. While the vaccine was most effective in people 60 to 69 years old, it also provided some protection for older groups. The most common side effects in people who got the vaccine were redness, soreness, swelling or itching at the shot site, and headache. The vaccine is not recommended in persons who are under 60. It is contraindicated in people who have not had chicken pox, or who have problems with their immune system (doctors call these people immunocompromised). This can happen with a malignancy or severe infection or in individuals undergoing treatment with chemotherapy. Certain medications, when taken for a long time, may weaken our "defense" system. The ones worth mentioning are systemic steroids (prednisone). Some people take steroids for asthma or certain forms of arthritis. The vaccine is also not recommended for anyone who has had a severe allergic reaction to gelatin or neomycin.

From your letter I do not get that you have any contraindications to this vaccine. Your neuropathy, prediabetes and even Raynaud's phenomenon (tips of fingers changing color and becoming painful with exposure to cold) are not, in my opinion, signs of a weak immune system. I agree with your doctor that it is safe for you to get it. It is quite expensive, about $250. It is NOT covered by Medicare B-plan covering flu and pneumonia shots. Some prescription plans may start covering the vaccine under Medicare D. You need to directly contact your prescription plan and ask them. Most people will end up paying for it out of pocket and it will be money well spent. Let me know what you have decided.

Dr. Beata Skudlarska is a Bridgeport geriatrician. Send questions to Bridgeport Hospital Center for Geriatrics, 95 Armory Road, Stratford CT 06614 or geriatricmd@aol.com.