When Kathy Yager awoke with a red bump on her forehead, she wrote it off as a mosquito bite. But later that day she had three painful welts above her right eye. She went to her doctor, who diagnosed her with shingles.
"I always thought it was something that happened to old people," said Yager, who was 55 when she got shingles in May.
Yager, who lives with husband David Boehne in South Lyon, Mich., started antiviral treatment immediately. But the painful red blisters still spread up past her hairline and down to her right eyelid, causing her eyelashes to fall out.
Seeing how miserable his wife was, Boehne asked his doctor for the shingles vaccine -- Zostavax. But the shot is currently only recommended for people older than 60. Boehne, then 52, had to get it "off-label" and foot the $280 bill.
With a million cases every year, about one in three people in the United States will get shingles, according to the Centers for Disease Control and Prevention. And while the majority of cases occur in people older than 60, anyone who has had chickenpox is at risk because the triggering virus, "herpes zoster," is the same.
"The chickenpox virus hibernates in the nerve cells of the spinal cord," said Dr. William Schaffner, chairman of preventative medicine at Vanderbilt University Medical Center. "And when it comes out of hibernation, it travels along those nerves to the surface of the body, causing a stripe of blisters that looks like shingles on a roof."
The rash usually forms in a single stripe curling around the left or the right side of the body. But it can occur on the face where, in severe cases, can leave disfiguring scars and even threaten vision.
Underneath the skin, the virus can damage and even destroy the nerve endings, causing postherpetic neuralgia; also known as post-shingles pain.
"Some people have a little, but some people have a lot, so much that it impedes their lives," Schaffner said.
Even the slightest irritation -- like a breeze through a T-shirt -- can trigger pain so severe that some people with post-shingles pain even consider suicide, Schaffner said.
"The pain is very difficult to treat and can last for months and, occasionally, even years," Schaffner said. "So shingles and post-shingles pain are clearly something you want to avoid."
The Elusive Vaccine
The Food and Drug Administration approved Zostavax for people older than 60 who've had chickenpox in 2006. The single shot decreases the risk of shingles by 55 percent, according to a Jan. 12 study in the Journal of the American Medical Association.
But only 10 percent of the 52 million people in the United States older than 60 have had the vaccine.
"Many people don't know that there is such a thing as a shingles vaccine and, frankly, not every doctor knows about it yet either," Schaffner said. "And even the doctors that do know about it may not be promoting it because it's very difficult for people on Medicare to get the vaccine."
Medicare covers the shot, which now runs about $160, for those older than 65 under its Plan D. But the reimbursement process is complicated. Unlike the flu shot -- which doctors can stock, administer and charge for -- doctors have to prescribe Zostavax and send patients to the pharmacy to get it.
Some pharmacies administer the shot. But ones that don't can leave patients "brown bagging" the temperature-sensitive vaccine back to the doctor's office.
"It's a terrible system," Schaffner said. "As I like to say, the shingles vaccine is akin to a brand new Jaguar, and we're keeping it in the garage."
There's also a problem on the manufacturing end. Merck -- the maker of Zostavax -- has reported a shortage of the essential ingredient: live but weakened chickenpox virus. But Merck has asked the FDA to broaden the recommendations to include people aged 50 to 59.
Shingles is rare in people under 50, but not unheard of. It tends to only affect younger people with weakened immune system, for whom live vaccines aren't recommended because of the potential to wake the dormant virus, according to the FDA.
Although Yager has no scars from the painful rash that left her wearing sunglasses and a baseball cap for four weeks, she still gets an itchy and sometimes painful sensation above her right brow.
"It will all of a sudden feel like somebody's sticking a needle in my forehead," Yager said. "And when I put makeup on, it feels like Novocain that hasn't entirely worn off."
Yager hopes the FDA extends the Zostavax recommendations so that insurers might cover the vaccine for people 50 to 59. But even at $160, she'd recommend getting it.
"Over having shingles?" she asked. "Definitely."