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Shingles Vaccine available at Quality Care, also Pneumonia and Flu Vaccine

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Post by sm1mex on Fri Nov 21, 2014 9:32 am

I am passing this on from the Drs. at Quality Care.

Hello Everyone, We have been asked numerous times about the shingles vaccine. It was not available in Mexico until now and we will have it at QualityCare for application starting next week. The stock we will have is going to be limited since the vaccine it self is also difficult to get at the moment. If you or someone you know is interested in getting this vaccine please let us know replying this email qcdoctors@gmail.com or call us at (376)7661870. You will find an attachment with some important information on the vaccine. The shingles vaccine is Zostavax.

Also we would like to remind you that this is the best season to get the flu shot and we have it available at QualityCare.

We are also offering the vaccine for Pneumonia. This vaccine is called Prevenar 13V, produced by Pfizer Inc. This is a conjugated vaccine for serotypes of Streptococcus pneumoniae strains 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F. It is indicated for active immunization for the prevention of invasive disease caused by S. pneumoniae. The most common causal organism of the most common of pneumonia: community acquired pneumonia. It is given as a single shot in individuals more than 60 years old and it does not require a booster.
In addition to the above, you can get any special vaccines that you might need. From pediatric to adult, including Hepatitis A, Hepatitis B, and Tetanus. If you have a special need feel free to ask

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Post by borderreiver on Sat Nov 22, 2014 3:55 am

Yikes. Very scary. I'm amazed, at 64, how I have lived this long without all these vaccines. Maybe drinking out of ditches at 5 helped. That would have been pre - vaccines. My mother and a nurse had a motto. "Let them eat dirt". Natural immunization, I'm thinking.
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Post by sm1mex on Sat Nov 22, 2014 8:32 am

Perhaps, but the shingles outbreak can be a very serious thing, especially if it breaks out on the head and migrates into the eye. It can cause blindness. Sometimes an ounce of prevention is worth more than a pound of cure !

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Post by gpbasap on Sat Nov 22, 2014 8:50 am

The primary clinical trial prior to Zostavax’s approval showed that it reduced risk of developing shingles by about 50 percent, but this isn’t as impressive as it sounds. In the placebo group, 3.3 percent of the study participants developed shingles, compared to 1.6 percent in the vaccine group. Yes, that’s a 50 percent difference, but the real, absolute risk reduction is just 1.7 percentage points.

Another way of looking at it is 175 people would have to be vaccinated to prevent one case of shingles, and 1,087 would need to be treated to prevent one case of postherpetic neuralgia (lingering nerve pain after an initial attack)—at a cost of $150–$300 per shingles vaccination.
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Post by sm1mex on Sat Nov 22, 2014 8:59 am

I had shingles in the U.S. My Dr. said I could get the vaccine and it should help but possibly not prevent 100%. I got the vaccine about 9 years ago and I have had only a very few minor outbreaks, so it has really help me, but it is not guaranteed 100%, but it can lessen the severity of the re-occurrence.

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Post by bimini6 on Sat Nov 22, 2014 12:37 pm

I personally would recommend the vaccine to anyone over 50 and the price here is a little less than out of pocket in the states. I don't know about Canada.

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Post by Pedro on Sat Nov 22, 2014 1:16 pm

borderreiver wrote:Yikes. Very scary. I'm amazed, at 64, how I have lived this long without all these vaccines. Maybe drinking out of ditches at 5 helped. That would have been pre - vaccines. My mother and a nurse had a motto. "Let them eat dirt". Natural immunization, I'm thinking.
good one and very true although a tetanus shot is a good idea. they last 10 years now. a pinche joven on a bicicleta ran into me while i was on my moto and cut my arm pretty good. time ta get a tetanus after 12 years.
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Post by Lady Otter Latté on Sat Nov 22, 2014 1:22 pm

Bimini, the risk of getting shingles for people in their 70s is about 1% during the next year (or 10% during the next 10 years). The rate is even lower for people in their 50s and 60s. Since added to that, the reported efficacy for the vaccine is 50%, I am curious why you recommend everyone be vaccinated.
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Post by bimini6 on Sat Nov 22, 2014 8:37 pm

Whether they've had shingles or not, adults age 60 and older should get the shingles vaccine (Zostavax), according to the Centers for Disease Control and Prevention (CDC). Although the vaccine is also approved for use in people ages 50 to 59 years, the CDC isn't recommending the shingles vaccine until you reach age 60.

The shingles vaccine protects your body from reactivation of a virus — the chickenpox (varicella-zoster) virus — that most people are exposed to during childhood. When you recover from chickenpox, the virus stays latent in your body. For unknown reasons, though, the latent virus sometimes gets reactivated years later, causing shingles. The shingles vaccine prevents this reactivation.

The shingles vaccine isn't fail-safe; some people develop shingles despite vaccination. Even when it fails to suppress the virus completely, however, the shingles vaccine may reduce the severity and duration of shingles. Although there's hope that the vaccine will reduce your risk of severe, lingering pain after shingles (postherpetic neuralgia), studies haven't yet found strong evidence of that effect.

The shingles vaccine is a live vaccine given as a single injection, usually in the upper arm. The most common side effects of the shingles vaccine are redness, pain, tenderness and swelling at the injection site, and headaches.

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Post by bimini6 on Sat Nov 22, 2014 8:40 pm

So, I recommend but by all means make your own decision. I have treated many with shingles and it is very painful and debilitating. The lingering effects can be devastating. One never knows when it will occur or the duration of each occurrence.

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Post by Lady Otter Latté on Sat Nov 22, 2014 9:27 pm

That is all true, but since the vaccine is very expensive and only effective half the time and my risk is 1% during the next year (or 10% during the next 10 years), I will pass. Others may come to a different decision. Thank you for taking the time to respond.
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Post by Pedro on Sat Nov 22, 2014 10:44 pm

call it what it is-herpes zoster and GASP! i agree with the crab eating otter. but hey! why not get shots fer everything-SNORK!
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Post by Hensley on Sun Nov 23, 2014 7:07 am

Lady Otter Latté wrote:Bimini, the risk of getting shingles for people in their 70s is about 1% during the next year (or 10% during the next 10 years). The rate is even lower for people in their 50s and 60s. Since added to that,  the reported efficacy for the vaccine is 50%, I am curious why you recommend everyone be vaccinated.

Friend from the US had it at 50 years old. Another friend here has it right now at 58.
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Post by Lady Otter Latté on Sun Nov 23, 2014 8:20 am

Hensley, their odds were even lower. Bad luck, But somebody has to get it. My odds are still the same.
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Post by Mexbaa on Sun Nov 23, 2014 9:51 am

I had it when I was sixteen. It was horrible and I had nerve pain for the two years following the outbreak. Surely there are better things to treat it now, but obviously it is still a miserable and painful experience.

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Post by simpsca on Sun Nov 23, 2014 10:15 am

Here is some information that suggests a higher rate of shingles for the elderly. I have several friends who have had it and it was terribly painful:

How Common is Shingles?
Scientists do not yet understand why some people who have had chickenpox never get shingles and some do. But about 30 percent of people in the U.S. will be diagnosed with shingles at some time in their lives. About half of the population of American 85-year-olds has had at least one case of shingles. Having it once doesn’t protect you from getting it again.
Nerve pain occurs in nearly a third of people with shingles who are 60 or older, and the pain appears to be worse and to last longer in older patients. About 12 percent of older people who have shingles have pain that lasts three months or more. Of these patients, about 18 percent will go on to develop postherpetic neuralgia, or chronic nerve pain. The risk of this complication increases to about one-third in patients over the age of 79.
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Post by Pedro on Sun Nov 23, 2014 11:03 am

oh boy! let's google all the diseases we can get and see if we're missing something by NOT getting them-SNORK!
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Post by Lady Otter Latté on Sun Nov 23, 2014 11:29 am

I still think my odds of getting hit by a car in the SuperLake parking lot are a lot higher than getting shingles.
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Post by Pedro on Sun Nov 23, 2014 11:31 am

Lady Otter Latté wrote:I still think my odds of getting hit by a car in the SuperLake parking lot are a lot higher than getting shingles.
holy sheet,i agree with you once more
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Post by Lady Otter Latté on Sun Nov 23, 2014 11:34 am

I know. I am getting ascared. Shocked
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Post by simpsca on Sun Nov 23, 2014 12:19 pm

You may be right about that. I got hit in the back door of Farmacia Guadalajara parking lot as someone backed into me without looking.
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Post by SunFan on Sun Nov 23, 2014 12:36 pm

A vaccination seems like a reasonable course of action.

There is little downside risk and as I understand it the odds of a Shingles attack are halved and symptoms reduced.

Better odds than one would get at the local Casino.

I'm scheduled for Thursday morning.

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Post by CanuckBob on Sun Nov 23, 2014 12:40 pm

Having contracted chicken pox at the age of 30 I can attest that the shingles wouldn't be fun.
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Post by Chapalamed on Sun Nov 23, 2014 1:08 pm

Here is some information about the SHINGLES VACCINE from my AAFP guidelines.
In the U.S. it is usually a patient's Primary Healthcare Provider(M.D., PA or RN) who advises the patient if it is indicated for him/her.

THE USE OF ZOSTER VACCINE
Indications for vaccination — We suggest zoster vaccination for the prevention of herpes zoster in people aged 50 years and older, including patients who have a prior history of herpes zoster (shingles), unless they have one of the contraindications listed below.
The United States Advisory Committee on Immunization Practices (ACIP) recommends beginning vaccination at age 60 years . However, we consider the data recommending vaccination in 50 to 59 year olds comparable to the data recommending vaccination in individuals aged ≥60 years, and the United States FDA has approved Zostavax for use in those 50 years and older.
For several reasons, it is not necessary to determine whether patients have a history of varicella or zoster prior to vaccination:
●A self-reported history of shingles is often of questionable reliability .

●Waning antibodies in previously exposed patients, particularly older adults, may lead to false negative results if serologic testing is performed.

●The herpes zoster vaccine has been safely administered to patients with a prior history of herpes zoster (shingles) .

In addition, we administer herpes zoster vaccination to patients 50 years and older who have received the varicella vaccine. Despite the lack of studies in such patients, we think that zoster vaccination could be beneficial since the varicella vaccine is composed of a live virus that can become latent (similar to the latency seen with wild type virus) and later reactivates to cause shingles . This differs from the position of the Centers for Disease Control, who does not recommended herpes zoster vaccination for patients who have received the varicella vaccine .
Zoster vaccine is not indicated for the treatment of herpes zoster or post-herpetic neuralgia.
Special considerations for the immunization of immunocompromised hosts and barriers to the use of the herpes zoster vaccine are discussed below.
Contraindications for vaccination — Zoster vaccine should NOT be administered to individuals with a history of an anaphylactic reaction to gelatin orneomycin . In addition, it should be avoided in populations that are at high risk for developing disseminated varicella-zoster virus infection since it is a live attenuated vaccine. This includes patients who:
●Are pregnant
●Have primary or acquired immunodeficiencies (including leukemia, lymphoma, or other malignancies affecting the bone marrow or lymphatic system)
●Are receiving cancer chemotherapy or radiation therapy
●Underwent solid organ transplantation
●Are receiving daily corticosteroid therapy with a dose ≥20 mg/day of prednisone (or equivalent) for ≥14 days
●Receive immunomodulatory therapy with rituximab or a tumor necrosis factor-alpha inhibitor
●Have HIV and a CD4 cell count <200 cells/microL

Receiving low-level immunosuppressive therapy (defined below) is not a contraindication for vaccination.
Formulation and administration — Zoster vaccine is administered as a one-time subcutaneous injection. It is a live attenuated vaccine that contains 18,700 to 60,000 plaque-forming units of virus, considerably more than the approximately 1350 plaque-forming units found in the Oka/Merck varicella-zoster virus vaccine for prevention of varicella.
The manufacturer of the pneumococcal polysaccharide vaccine (PPSV23) and the zoster vaccine states that clinicians should consider administering these two vaccines at least four weeks apart because the coadministration of PPSV23 may reduce the immunogenicity of the zoster vaccine . However, to avoid introducing barriers to patients receiving indicated vaccines, the United States Centers for Disease Control and Prevention recommends that PPSV23 and the zoster vaccine be administered at the same visit if the patient is eligible for both vaccines . This recommendation is based upon data from an observational study that did not find a difference in the rate of herpes zoster among those who received both vaccines concurrently compared with those who received the vaccines four weeks apart .
Issues of vaccination in immunocompromised patients — The risk for zoster and its associated morbidity and mortality is much greater among persons who are immunocompromised. The decision to vaccinate depends upon the age of the patient and their degree of immunosuppression. Zoster vaccine is not recommended in patients who are highly immunocompromised.
Vaccination before immunosuppression — Whenever feasible, it is optimal to vaccinate patients prior to the initiation of immunosuppressive therapy. Zoster vaccination should be administered to patients ≥4 weeks before the initiation of immunosuppressive therapy if they do not have a history of zoster vaccination .
Patients receiving low-level immunosuppression — We agree with the guidelines of the Infectious Disease Society of America (IDSA) that support vaccination of patients who are receiving therapies that induce low levels of immunosuppression. These therapies include :
●Low-dose prednisone (<2 mg/kg: maximum ≤20 mg/day) or equivalent
●Methotrexate (≤0.4 mg/kg/week)
●Azathioprine (≤3 mg/kg/day)
●6-mercaptuporuine (≤1.5 mg/kg/day)

HIV-infected patients — Zoster vaccine is not recommended for HIV-infected patients with a CD4 cell count <200 cells/microL. The use of herpes zoster vaccination in other HIV-infected patients is discussed elsewhere.
Solid organ and hematopoietic stem cell transplant patients — The use of herpes zoster vaccination and/or antiviral medications to prevent zoster in transplant candidates and recipients is discussed elsewhere.
Transmission of vaccine virus — Healthy immunocompetent individuals who live in a household with immunocompromised patients should receive the herpes zoster vaccine according to the same recommendations presented above (see 'Indications for vaccination' above) . In clinical trials, transmission of the vaccine virus has not been reported . However, according to the vaccine package insert, post-marketing experience suggests that transmission of vaccine virus to immunocompromised contacts may occur rarely from vaccine recipients who develop a varicella-like rash. In such cases, immunocompromised patients should avoid contact with persons who develop skin lesions resulting from the zoster vaccine until the lesions clear .
ADVERSE EVENTS — The herpes zoster vaccine is generally well tolerated . In a randomized placebo-controlled trial with enrollment from 1998 to 2001 (n = 38,546 immunocompetent adults), the most common side effect after administration of herpes zoster vaccine was pain at the injection site . There were no documented episodes of disseminated vesicular rash linked to the vaccine virus. Long-term follow-up through 2004 showed that rates of hospitalization or death did not differ between vaccine and placebo recipients . In a 2012 meta-analysis, vaccine-related systemic adverse effects were more frequent in the vaccinated group (RR 1.29, 95% CI 1.05-1.57) . Side effects were more frequent in individuals from 60 to 69 years than in those ≥70 years of age.
Two cases of acute retinal necrosis (ARN) following herpes zoster vaccination have been reported; the patients developed loss of vision six days and two months following vaccination, respectively. Varicella-zoster virus was detected from the vitreous or aqueous by polymerase chain reaction in both patients. Since it is not known whether the viruses that caused ARN were identical to the vaccine strain, it is not clear whether the episodes of ARN were caused by vaccination. Both patients were over 75 years of age and one was immunocompromised, having undergone renal transplantation. As noted above, herpes zoster vaccination is contraindicated in immunocompromised patients because it is a live virus vaccine.
Vaccine associated varicella-zoster virus can also establish latency, and in rare cases, can reactivate to cause clinical zoster. In one immunocompetent patient, for example, localized herpes zoster infection occurred nine months after vaccination, and virologic studies confirmed that the infection was caused by the vaccine strain of virus .
All clinically significant events should be reported to the Vaccine Adverse Events Reporting System (VAERS) at http://www.vaers.hhs.gov or by telephone (800-822-7967).
BARRIERS TO USE — In 2011, only 16 percent of adults aged ≥60 years reported receiving herpes zoster vaccination to prevent shingles . The reasons for such low utilization despite national recommendations are as follows:
●Cost ― The major barrier to the widespread use of zoster vaccine is cost . Herpes zoster vaccine is the most expensive vaccine routinely recommended for older adults, and only about half of general internists stock the vaccine in their offices . In addition, many clinicians do not know that the herpes zoster vaccine is reimbursed by insurance carriers .

●Vaccine coadministration ― Decreased utilization of the herpes zoster vaccine may also be a result of the manufacturer’s recommendation that the herpes zoster vaccine be administered separately from the pneumococcal vaccine. To minimize the effects of this barrier, the Centers for Disease Control has recommended the coadministration of pneumococcal and herpes zoster vaccines.


The rep from Merk also stated that they could provide the measures to transport the vaccine to my office if I were to opt to sell it. I would have to investigate further about those measures and decide whether or not in my opinion this mode would decrease the efficacy of the vaccine.  



Hope this information helps people and their primary Healthcare provider decide if it is right for them.


HERE IS A LINK of the current U.S. Guidelines for VACCINES. Hope it helps you.

http://www.uptodate.com/contents/image?imageKey=ID%2F62130&topicKey=ID%2F3884&source=see_link
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Post by Pedro on Sun Nov 23, 2014 9:12 pm

wadda crock!
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