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Shingles Vaccine

Post by Jim W on Mon Dec 23, 2013 4:24 pm

Is the Shingles vaccine available in Mexico, and if so how much  do they cost?

TIA,  Jim W
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Re: Shingles Vaccine

Post by borderreiver on Mon Dec 23, 2013 9:46 pm

Avoid. Read the complications. Live Lakeside. Wash hands often. Breath deep. Be Happy.

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Re: Shingles Vaccine

Post by CheenaGringo on Mon Dec 23, 2013 9:51 pm

I believe it is required before one can visit Cuba?

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Re: Shingles Vaccine

Post by Pedro on Mon Dec 23, 2013 10:25 pm

CheenaGringo wrote:I believe it is required before one can visit Cuba?
get real
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Re: Shingles Vaccine

Post by arbon on Tue Dec 24, 2013 8:41 am

The Shingles vaccine can give you the shakes.

or so I have read.
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Re: Shingles Vaccine

Post by BobC on Tue Dec 24, 2013 9:53 am

arbon wrote:The Shingles vaccine can give you the shakes.

or so I have read.

After we saw what shingles were like for my mother (diagnosed by a quack in a walk-in clinic as bronchitis without even looking at her chest and so was past the point of anti-viral treatment when correctly diagnosed), when we found out the vaccine was available we got it right away-- at our own expense!

I would be surprised if it has any side effects, but certainly we didn't. In any case, I would take any side effect--including death-- rather than go through what she did!

Bob

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Re: Shingles Vaccine

Post by sundown on Tue Dec 24, 2013 11:25 am


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Re: Shingles Vaccine

Post by Pedro on Tue Dec 24, 2013 11:39 am

arbon wrote:The Shingles vaccine can give you the shakes.

or so I have read.
it would be horrible to get those shakes if they were infected bc pine
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Re: Shingles Vaccine

Post by BobC on Tue Dec 24, 2013 12:18 pm

Pedro wrote:
arbon wrote:The Shingles vaccine can give you the shakes.

or so I have read.
it would be horrible to get those shakes if they were infected bc pine

Shakes are always better than shingles (cedar vs. asphalt/fibreglas)!  Very Happy 

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Re: Shingles Vaccine

Post by sm1mex on Tue Dec 24, 2013 3:21 pm

A local Drs. office told me they have been trying to get the shingles vaccine for 3 years but it is not available yet here.

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Re: Shingles Vaccine

Post by juanrey on Tue Dec 24, 2013 3:31 pm

borderreiver wrote:Avoid. Read the complications. Live Lakeside. Wash hands often. Breath deep. Be Happy.

Counterpoint - Father-in-law got them at 87, didn't think it was so bad.  He was wrong.  From the time he got it till the time he died was < 6 mos.  Not saying shingles typically kills you, but you can get complications that can.

Daughter got them at 45, immediately went to Dr.  Got salve and medication and was miserable for nearly 2 weeks with lingering effects for 2 more.
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Re: Shingles Vaccine

Post by BobC on Tue Dec 24, 2013 3:51 pm

My mother was in her 80's when she got them and looked like she was in her 60's. (People used to ask if she and my wife were sisters--much to my wife's chagrin.)    

Then she got shingles as described above. She said that she had heard of people committing suicide because of the pain and said she could understand why. The worst pain lasted the better part of a year. After that, she looked her age and then some. She still gets stabs of pain. But, she is 90 and still around.

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Re: Shingles Vaccine

Post by Jim W on Tue Dec 24, 2013 5:24 pm

I got mine today......Shingles vaccine @ pharmacy $225.00. Fortunately, Medicare picked up over 1/2, cost me $95.00 and the pneumonia booster was no charge.

I have heard horror stories about shingles and hopefully will avoid them now.
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Re: Shingles Vaccine

Post by Hensley on Wed Dec 25, 2013 8:02 am

My poor Mom had them for close to a year, what a miserable time. if people have gotten them at 45 then why won't they give the shot to you before 60?

I had chicken pox in my 20's and that was really bad, I would hate to have shingles.

Don't get stressed out, that is how my Mom ended up with them.
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Re: Shingles Vaccine

Post by Jim W on Thu Dec 26, 2013 5:40 pm

Possible side effects say nothing about the shakes. I've had no side effects. Possible reactions include swelling of the tongue lips, mouth, or face, hives or itching.....there are a few more, however, my scanner is screwed up.

Check out the meds on Google, Zostavax for more info. Research Shingles, and make your own decision.
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Re: Shingles Vaccine

Post by simpsca on Thu Dec 26, 2013 6:02 pm

I've had several friend who had shingles and will do anything to avoid getting them - it'a a terrible disease. I got the shot to prevent them in the US. I understand it's not available here in Mexico.
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Re: Shingles Vaccine

Post by lunateak on Thu Dec 26, 2013 7:47 pm

I believe it was only approved this year for use in Mexico.
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Re: Shingles Vaccine

Post by Jim W on Thu Dec 26, 2013 7:51 pm

By all reports, it is a nasty deal......getting vaccine can save much pain.....probably will be expensive here for a while!
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Re: Shingles Vaccine

Post by Chapalamed on Thu Dec 26, 2013 9:35 pm

As far as I know, the Herpese Zoster Vaccines is not available in Mexico at this point in time.
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Re: Shingles Vaccine

Post by Dr. Sam Thelin on Sat Dec 28, 2013 9:45 am

Jim W wrote:By all reports, it is a nasty deal......getting vaccine can save much pain.....probably will be expensive here for a while!

The severity of the symptoms vary from person to person. The vaccine should only be your PLAN "A". It is not insurance that you will not get the shingles. "Vaccine Efficacy: In a clinical trial involving more than 38,000 adults 60 years of age or older, the vaccine reduced the overall incidence of shingles by 51% and the incidence of PHN by 67%. The efficacy of the vaccine in preventing shingles was higher in the younger age group (60-69 years; vaccine efficacy was 64%) than in the older age group (older than 70 years; vaccine efficacy was 38%).

Studies are ongoing to assess the duration of protection from one dose of zoster vaccine and the need, if any, for booster doses."
http://www.cdc.gov/vaccines/vpd-vac/shingles/hcp-vaccination.htm

You also need a PLAN "B" in case PLAN "A" (the vaccine) does not work or you cannot get the vaccine. Rapid identification and treatment will also save you much pain. You need to be able to identify it as soon as possible. It looks like this: http://www.livestrong.com/article/19248-shingles-virus-look-like/

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Re: Shingles Vaccine

Post by simpsca on Sat Dec 28, 2013 10:11 am

I feel better that I am in the younger age group for efficacy Dr. Sam. But what is the treatment if one does get shingles any way. I've seen a wide variety of treatments lakeside, from Lyrica to pain killers such as anti inflammatory meds to tramadol.
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Re: Shingles Vaccine

Post by Dr. Sam Thelin on Wed Jan 01, 2014 9:32 am

simpsca wrote:I feel better that I am in the younger age group for efficacy Dr. Sam. But what is the treatment if one does get shingles any way. I've seen a wide variety of treatments lakeside, from Lyrica to pain killers such as anti inflammatory meds to tramadol.

The first thing would be to try to identify actually having shingles in its first stage (the time that it starts and is getting worse due to viral replication). If it can be identified in the first 24 hours, nucleoside analogue drugs such as acyclovir, which is a guanosine analogue antiviral drug, can be given, and will halt the progression of the outbreak so it does not get any worse. If it is not treated until later, the treatment is simply pain control and sometimes an antibiotic to prevent bacterial infection from the open sores. The pain is not well-controlled with typical non-steroidal anti-inflammatory drugs, and is better controlled using various medications that work on the overstimulation of the nerves such as antiepileptic medications. Yes, Lyrica (pregabalin) is one that can be used or simply gabapentin which both contol the voltage-dependent calcium channels of the nerves, or stronger ones like carbamazepine that controls the sodium channels of the nerves, or its newer, safer (more expensive) version oxcarbazepine. Opioids (such as tramadol) also will help. Due to the side-effects of all the different drugs that can be used, it is highly recommended that you talk with your doctor as soon as possible to see which medication is the best option. Nucleoside analogue drugs require a prescription, as do opioids stronger than tramadol.

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Re: Shingles Vaccine

Post by Fig on Wed Jan 01, 2014 2:57 pm

I've had a shingles outbreak and narrowly averted another by taking Apo-Valacyclovir 500 mg.   I try to keep a prescription to be filled at the first sign of the tingling sensation that preceeds the outbreak - this needs to be done within 48 hrs.   The drug is very expensive here in Canada - Dr. Sam - is a prescription required for this in Mexico? thanks.

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Re: Shingles Vaccine

Post by Chapalamed on Wed Jan 01, 2014 5:46 pm

Since the topic has now been steered toward treatment, here are the latest treatment guidelines according to the latest medical literature I subscribe to:

GOALS OF THERAPY — Important goals of antiviral therapy are to :

Lessen the severity and duration of pain associated with acute neuritis
Promote more rapid healing of skin lesions
Prevent new lesion formation
Decrease viral shedding to reduce the risk of transmission
Prevent post-herpetic neuralgia

AVAILABLE (DRUGS) AGENTS — The nucleoside analogues acyclovir, valacyclovir, and famciclovir are the preferred antivirals for treatment of acute herpes zoster infections. Although oral acyclovir (800 mg five times daily) has been the mainstay of herpes zoster treatment, its poor bioavailability and need for frequent daily dosing prompted the development of later generation antiviral agents (valacyclovir and famciclovir) with improved pharmacokinetics and lower dosing frequency. Famciclovir, the prodrug of penciclovir, is well absorbed from the gastrointestinal tract and is rapidly converted in the intestinal wall and liver to the active compound penciclovir, which has broad activity against VZV. Valacyclovir is also well absorbed from the gastrointestinal tract and rapidly converted to acyclovir in vivo, thereby providing a three- to fivefold increase in acyclovir bioavailability.  
SIDE NOTE - This information is very important when your doctor is taking into account your pre-existing conditions as they may decrease the efficacy of these meds in your case.

These nucleoside analogs have well-established safety records and are generally well tolerated at the currently recommended doses. Adverse events can include nausea, diarrhea, or headache.

CLINICAL TRIAL DATA ON ANTIVIRAL THERAPY — Several lines of evidence suggest that antiviral therapy hastens resolution of cutaneous lesions and the acute neuritis of herpes zoster .

Whether antiviral therapy prevents post-herpetic neuralgia (PHN) is not as clear because of conflicting study results. However, the evidence is limited by different methodologies of pain assessment, definitions of PHN, and length of follow-up . Subsequent meta-analyses have also differed in their conclusions depending on which studies were included and the PHN definitions that were used. One expert suggested that the definitions of acute neuritis and PHN were artificial; it was suggested that the effect of antiviral therapy should be measured as a continuum from the onset of rash to resolution to better determine the impact on the duration of pain, whether acute, subacute, or chronic.

Clinical trial data regarding the efficacy of acyclovir, famciclovir, and valacyclovir, are discussed below.

Acyclovir — Administration of acyclovir within 48 to 72 hours of the onset of rash has demonstrated clinical benefit in the treatment of acute neuritis and in the prevention of post-herpetic neuralgia.

In a meta-analysis of four placebo-controlled trials involving 691 patients (mean age 62 years), acyclovir (800 mg five times daily) was associated with a lower prevalence of acute neuritis (HR 1.46; 95% CI 1.1-1.93) and post-herpetic neuralgia, defined as the presence of pain at three and six months after resolution of rash (HR 1.8; 95% CI 1.35-2.43) . In a subsequent meta-analysis, which included one additional placebo-controlled trial, antiviral therapy decreased the risk of post-herpetic neuralgia (as defined by any pain at six months) by 46 percent .

Famciclovir — A placebo-controlled clinical trial was conducted in 419 immunocompetent adults (mean age 50 years) with uncomplicated zoster to evaluate the efficacy of standard dose famciclovir (500 mg three times daily) or high dose famciclovir (750 mg three times daily) for the treatment of acute zoster and prevention of PHN . All patients were initiated on the intervention, or placebo, within 72 hours of rash and were treated for seven days. Of note, PHN was defined as any pain occurring after rash resolution. After five months of monthly follow-up, the intention-to-treat analysis demonstrated that:

Famciclovir was associated with modest improvement in lesion healing rates (median five to six days with low- and high-dose famciclovir) compared with placebo (median seven days).
There was no difference in the incidence of PHN among the three arms. However, compared with placebo, the median duration of PHN was reduced by approximately two months with famciclovir therapy, regardless of dose (62 and 55 days with low- and high-dose famciclovir, respectively, compared with 119 days with placebo).  
Although one trial demonstrated comparable rates of resolution of acute neuritis with once-daily dosing of famciclovir (750 mg daily) as compared to acyclovir (800 mg five times daily), no results were reported for the outcome of post-herpetic neuralgia .

Valacyclovir — In a randomized, double-blind study of 1141 immunocompetent adults with herpes zoster (mean age 68 years), the efficacy and safety of valacyclovir (1000 mg orally three times daily for 7 or 14 days) was compared with acyclovir (800 mg orally five times daily for seven days) over six months of follow-up. In an intent-to-treat analysis:

Valacyclovir for 7 or 14 days accelerated the resolution of acute neuritis (median duration of pain 38 and 44 days, respectively) compared with acyclovir (median 51 days).
The proportion of patients with pain persisting for six months was modestly lower in the combined valacyclovir arms (19 percent) compared with the acyclovir arm (26 percent). No additional benefit was observed with a longer duration of valacyclovir.
Cutaneous lesion resolution occurred at similar rates in all treatment groups
Adverse events were similar among all arms
In a smaller controlled trial that compared valacyclovir with famciclovir, there were no differences in rates of resolution of acute neuritis or PHN; safety profiles were similar.

MANAGEMENT OF UNCOMPLICATED HERPES ZOSTER — The approach to the patient with uncomplicated zoster is discussed below. Herpes zoster can also lead to ophthalmic and central nervous system complications, which are discussed elsewhere.

General principles — The management of uncomplicated zoster includes antiviral therapy to hasten healing of cutaneous lesions and to decrease the duration and severity of acute neuritis. Whether antiviral therapy decreases the risk of post-herpetic neuralgia is less clear. (See 'Clinical trial data on antiviral therapy' above.)

Analgesia is also important for pain control for patients with moderate to severe acute neuritis. There is no clear role for other adjuvant therapies, such as glucocorticoids or tricyclic antidepressants, as discussed below.

The treatment of established post-herpetic neuralgia is discussed elsewhere.

Antiviral therapy

Patents over 50 years of age (Which accounts for the majority of the patient population that CHAPALA MED treats) — We recommend antiviral therapy for patients >50 years of age with uncomplicated herpes zoster who present within 72 hours of clinical symptoms. Acyclovir, famciclovir, and valacyclovir have all demonstrated clinical benefit and safety in the treatment of herpes zoster in immunocompetent patients. However, we prefer valacyclovir or famciclovir compared with acyclovir based on the convenience of less frequent dosing . The selection of drug may also be influenced by cost considerations. The duration of treatment is seven days; dosing is as follows:

Acyclovir 800 mg five times daily
Famciclovir 500 mg three times daily
Valacyclovir 1000 mg three times daily
Patients under 50 years of age — The efficacy of antiviral therapy in patients less than 50 years of age has not been as well studied. In the meta-analysis cited above, the benefit of acyclovir therapy was seen in all patients, but was greatest in patients older than 50 years of age, in whom the pain of zoster generally persists longer.

However, the risk of adverse events secondary to antiviral therapy is very low, and early treatment can decrease symptoms of acute neuritis and hasten resolution of cutaneous lesions. Thus, we generally give antiviral therapy to patients <50 years of age with herpes zoster who present within 72 hours of clinical symptoms.

Timing of therapy — AGAIN, Antiviral therapy should be initiated WITHIN 72 hours of clinical presentation in patients greater than 50 years of age to maximize the potential benefits of treatment. The clinical utility of initiating acyclovir therapy more than 72 hours after the onset of lesions in the immunocompetent host is unknown. However, treatment should be considered if new lesions are still appearing at that time of clinical presentation, indicating ongoing viral replication. There is likely minimal benefit of antiviral therapy in the patient who has lesions that have encrusted.

The rapid initiation of therapy is particularly critical in the severely immunocompromised patient, such as the organ transplant recipient. Antiviral therapy should be initiated in all immunocompromised patients, even if they present after 72 hours. Immunocompromised hosts with disseminated zoster should be hospitalized for intravenous acyclovir therapy.

Analgesia for acute neuritis — Although antiviral therapy reduces pain associated with acute neuritis, pain syndromes associated with herpes zoster can still be severe. Nonsteroidal anti-inflammatory drugs and acetaminophen are useful for mild pain, either alone, or in combination with a weak opioid analgesic (eg, codeine or tramadol). For moderate to severe pain that disturbs sleep, stronger opioid analgesics (eg, oxycodone or morphine) may be necessary.

In a clinical trial of 87 patients taking famciclovir for a new diagnosis of herpes zoster, the use of gabapentin was not more effective than placebo as adjuvant therapy for acute neuritis.

Use of glucocorticoids — Glucocorticoids have been used in combination with acyclovir for the treatment of uncomplicated acute herpes zoster in an attempt to improve the quality of life, the time to healing of lesions, and to reduce the incidence of post-herpetic neuralgia. Early trials suggested a modest benefit of glucocorticoids on a limited number of clinical outcomes with an increased risk of adverse events.

However, a subsequent meta-analysis of five placebo-controlled trials evaluating acyclovir alone compared with acyclovir plus glucocorticoids did not demonstrate any benefit of combination therapy on quality of life or the incidence of post-herpetic neuralgia. Furthermore, corticosteroids could potentially increase the risk of secondary bacterial skin infection. Thus, we do not recommend the routine use of corticosteroids in addition to antiviral therapy.

Use of tricyclic antidepressants — There is unconvincing direct evidence for a role of tricyclic antidepressants in managing acute neuritis or in preventing post-herpetic neuralgia.

A placebo-controlled trial of amitriptyline for 90 days among 80 patients with herpes zoster found that the risk of post-herpetic neuralgia was reduced by more than 50 percent among patients who were assigned to the intervention arm [32]. However, there are multiple limitations to this trial: a) antiviral therapy was prescribed according to the discretion of the practitioner and only a minority of patients received acyclovir; b) a standardized questionnaire was not used to determine the severity of pain; c) pain symptoms were collected retrospectively, which may have led to recall bias; d) the patients were not stratified at baseline for factors associated with increased risk of post-herpetic neuralgia. Thus, the additive benefit of tricyclics for pain reduction cannot be assessed from this trial.

The risk of adverse events related to tricyclic antidepressants is also increased in elderly patients. Thus, we do not recommend the addition of tricyclic antidepressants for the prevention of post-herpetic neuralgia based on the available data.

The use of tricyclic antidepressants and other adjuvants in established post-herpetic neuralgia are discussed elsewhere.

PATIENT MONITORING

Viral load monitoring — At present, there is no indication for monitoring viremia during treatment in patients with acute VZV since the height of the viral load does not correlate with the development of post-herpetic neuralgia or duration of symptoms.

Pain control — As noted above, pain management of acute neuritis is integral for patient management. Serial patient monitoring should include standardized pain measures and frequent follow-up to assess efficacy in relief of symptoms [16].

As noted above, approximately 10 to 15 percent of patients may also develop post-herpetic neuralgia. The management of the pain associated with PHN is another topic altogether and I have experienced successful treatments when the medications are individualized for each patient.

And these ANTIVIRALS are available only by prescription and I advise all not to self-medicate themselves with such meds.
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Re: Shingles Vaccine

Post by joyfull on Tue Jan 07, 2014 8:41 pm

Jim W wrote:I got mine today......Shingles vaccine @ pharmacy $225.00.  Fortunately, Medicare picked up over 1/2, cost me $95.00 and the pneumonia booster was no charge.    

I have heard horror stories about shingles and hopefully will avoid them now.
jim...do you carry part D with Medicare? Where did you get the shot? Am going to the U.S. this month and want to get one. Have Medicare and AARP Part D through United healthcare.
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Re: Shingles Vaccine

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