Norma Farber, 70, was diagnosed with shingles on October 6, 2006. Although the painful rash lasted only for ten days, she was one of a large percentage of older people who suffer post-herpetic neuralgia – long lasting and severe pain after the shingles rash disappears. She could not stand clothes touching her affected skin. Sitting down was painful and bending down impossible. It was not until early February that she was able to start reducing the strong pain medication that affected her focus and prevented her from driving and reading.

Farber urges her friends, "Run, don't walk, and get that new shingles vaccine."

Having shingles is not fun. Anyone who has had chicken pox as a child is vulnerable. About 25 per cent of these will get shingles during their lifetimes, the risk increasing with age. Some 40 per cent of people over 60 will get post-herpetic neuralgia. This risk goes up to almost 50 per cent for people over 70.

The good news is that the pharmaceutical company Merck has developed a vaccine - called Zostavax. Studies show that Zostavax reduces the occurrence of shingles by about 50 per cent and post-herpetic neuralgia by 67 per cent. Side effects are minimal, sometimes including headache and reactions at the injection site.

The Federal Drug Administration licensed Zostavax last May. In October, the Advisory Committee on Immunization Practices, a federal panel of immunization experts, recommended that Zostavax be given to all people aged 60 and over, including those who have had a previous bout of shingles. In late November, the Centers for Disease Control and Prevention posted its provisional recommendations, concurring with the ACIP. Final CDC approval is scheduled for later this year, when its recommendations will be published in the Morbidity and Mortality Weekly, a CDC bulletin read by most health care professionals. It is expected that final CDC approval will result in more physicians recommending Zostavax for their older patients.

The bad news is that the vaccine is expensive, $150 for the one-shot dose, with physicians charging $15 - $20 for administering it. Insurance plans and Medicare are just starting to reflect it in their reimbursement policies. At first, traditional Medicare would not reimburse for any of the cost of Zostavax, leaving partial payment to some of the drug plans available under Medicare D, the new prescription drug benefit. In late January, however, traditional Medicare started to pay for the cost of administering the vaccine, if the beneficiary buys Zostavax through a Part D plan.

If you are uninsured and have an annual income below $19,600 (single) or $26,400 (couple). Merck will provide Zostavax free of charge through your physician. Go to www.merckhealth.com or call 1-800-293-3881.

Zostavax must be kept frozen until it is administered, which creates a problem in some physician offices. Merck has developed a non-frozen alternative, but it is currently marketing it outside the United States. Also, although some American physicians are already ordering the vaccine and administering it in some parts of the country, Zostavax is not readily available everywhere. In the Burlington area, for example, it has been in short supply, notes Lynne Vezina, pharmacist at the Vermont Family Pharmacy on North Avenue.

Although Zostavax reduces your chances of getting shingles by half, it does not assure immunity. You still should be prepared for action if you get it.

Some 95 per cent of Americans over 60 years old had chickenpox when they were children. Few think about this common illness coming back to haunt them as they grow older. But the virus that causes chicken pox does not leave your body when the illness is over. Lying dormant for decades in nerve cells, the virus can reactivate much later in life, when your body's defenses are low. That is shingles.

"The most important thing to know about shingles," says Richard Tonino, MD, a geriatrician practicing in South Burlington "is to catch it early."

Shingles is common in older people, says Tonino. "We see it at least once a week." The symptoms may be vague at first – numbness, tingling, itching, or pain before the classic chicken pox-like rash appears. Before the rash, diagnosis may be difficult, and the sometimes severe pain may be mistaken for symptoms of pleurisy, kidney stones, gallstones, appendicitis, or even low back pain or sciatica, depending on the location of the affected nerve.

In two to five days after the first symptoms, the rash appears and clinches the diagnosis. Like chicken pox and poison ivy, the rash usually begins as clusters of small bumps that soon develop into blisters. The distribution of the rash marks it as shingles. The blisters follow a straight line – the pathway of a single nerve – in a band two to six inches wide, usually around one side of the body. The rash typically runs from your spine around your torso to the front mid-line. But it can also appear on your face, neck, or scalp, along your jaw, outside and inside your ear, and on your buttock or down your leg.

The blisters eventually break open, form scabs, and the skin heals, pain fading in about a month. Most healthy people recover fully. But many people over 60 develop long lasting pain. The pain can be very severe and last months, even years. "It can drive people to suicide," Tonino says.

As soon as you see the rash, Tonino says, see your doctor. If you take anti-viral medications within 72 hours of when the rash appears, you can limit the initial illness and reduce the risk for long-lasting pain.

Tonino sees Zostavax as "quite good for the prevention of a potentially long-term painful problem. There are issues in terms of getting insurance companies to pay for it and in terms of freezing and reconstituting the product. But these will likely straighten out over time."

Barbara Leitenberg writes on senior issues for the Champlain Valley Agency on Aging. This article originally appeared in the Burlington Free Press.