Dear Dr. Roach: I am an 84-year-old female. Luckily for me, I have never been ill with chickenpox, measles or mumps. My family doctor thought that I should still get the shingles vaccine, even though a blood test proved that, indeed, I'd never had chickenpox. So I did. I read in the paper that there is a new shingles vaccine available and that everyone should get the new shot as a followup to the first. Do I really need to do that?
B.B.
I am getting many questions about the new Shingrix vaccine. It is recommended for adults over 50, with or without a history of chickenpox or shingles. It also is recommended for people who have already had the older shingles vaccine, Zostavax.
Shingrix is much more effective than Zostavax, and the side-effects are mostly local and do not last more than a day or two. Further, Zostavax’s effectiveness begins to wane after eight years or so, and Shingrix seems to have a much longer period of protection. Shingles at an older age is a very painful condition, and some people have pain that lasts for months or years.
Yours is a rare situation, in that you have laboratory evidence proving you have never had chickenpox. More than 99 per cent of adults have had chickenpox. Shingrix has not been tested in this situation, and the Centers for Disease Control and Prevention recommendations as of this writing would be for you to get the primary vaccine for chickenpox (two doses) and then get the zoster vaccine. You had the zoster vaccine (Zostavax), not the chickenpox vaccine (Varivax), which is not what would be recommended; however, it can count as the first of the two chickenpox vaccines. You need to wait a minimum of eight weeks before getting the Shingrix vaccine.
I suspect these recommendations may change in the future as we get more understanding of the effectiveness of the Shingrix vaccine.
Dear Dr. Roach: I just read your response to H.W.’s inquiry about “flesh eating” bacteria and am surprised that you indicated that surgical intervention is the primary treatment. I have read many articles about individuals being diagnosed with necrotizing fasciitis who then underwent massive tissue debridement that could have been delayed or avoided by first considering the possibility of an anaerobic gas bacillus type organism as the culprit.
I have seen firsthand the dramatic effect of hyperbaric oxygenation therapy has to turn these cases around, and I am dismayed that this type of treatment is not considered before drastic surgeries are performed. I think that a few treatments of hyperbaric oxygenation would not hurt and could be diagnostically valuable and perhaps therapeutic. It seems that there are many clinicians out there who don't even know about HBO.
T.C.
Hyperbaric oxygen, the use of pure oxygen under pressure in a tank, has been used for serious infections such as gas gangrene and in necrotizing fasciitis. High concentrations of oxygen are toxic to these bacteria. Its use is limited to centres with the expensive equipment. Most studies have shown that it provides a significant benefit to early, aggressive surgical treatment. It is never used instead of surgical treatment, as the oxygen needs to get to the bacteria and won’t until surgery. It certainly can hurt if it delays definitive surgical treatment.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
