Polio Place

Frederick M. Maynard, Chair, PHI Medical Advisory Committee, Marquette, Michigan

Members of PHI concerned that polio survivors might have abnormalities of the immune system questioned if taking the vaccine would either increase the risk of complications or make them less effective.

In early 2013 PHI distributed a six question survey through its PHI Membership Memo, website (post-polio.org) and Facebook. The PHI Association Member Communiqué asked support groups to recruit survey takers who had polio from their memberships.

By late April, 293 people completed the survey. 64% of respondents (186) had taken the shingles vaccine (Zostavax®). Only 6 of these respondents (3%) reported any problems as a result of taking the vaccine.

Among the 4 respondents who described their problem, two reactions were mild with transient aching at the vaccine injection site. One, who took the vaccine after having had a case of shingles, described persistent itching at the injection site.

One individual reported fainting while exercising about two weeks after taking the vaccine, which most likely was coincidental. These side effects are similar to those reported in non-polio survivors (ref. 1).

Regarding the vaccine’s effectiveness, 8 of 186 respondents (4.3%) reported developing a case of shingles after having received the vaccine. All of the cases were described as mild and no one reported postherpetic neuralgia (nerve pain), the severe persistent pain problem that is the most feared complication of having shingles. The worst case was described as “not severe but pretty painful and a downright nuisance.”

Since the respondents received their vaccine a mean of 2.9 years before answering the survey, they represent about ‘531 person years’ at risk for developing shingles. These numbers suggest an estimated incidence of clinical shingles among post-polio individuals who have taken the vaccine as 15 cases per 1000 patient years. This compares to a rate of 11.1 cases per 1000 patient years among placebo vaccine recipients and 5.4 cases per 1000 patient years among immune-competent over age 60 vaccine recipients in the largest and best designed study of the vaccine’s effectiveness (ref.2).

Because PHI’s survey was open to all its contacts and was voluntary, it undoubtedly had a responders’ bias among its sample for people who had received the vaccine and still developed a clinical case of shingles (not laboratory confirmed).

In summary, our survey’s estimated rate of developing shingles in spite of receiving the vaccine suggests that the shingles vaccine is most likely as effective among polio survivors as in people who never had polio, especially in preventing severe cases with disabling pain.

The low number of responders with side-effects after receiving the vaccine is also reassuring that its use is similarly safe for polio survivors. Given the high rate of shingles among older Americans, survivors of polio with a competent immune system are encouraged to receive the shingles vaccine.

References: 1) Simberkoff MS, RD Arbeit, et al. Safety of Herpes Zoster Vaccine in the Shingles Prevention Study. Ann Int Med 2010; 152:545-554.

2) Oxman MN, MJ Levin, et al. A Vaccine to Prevent Herpes Zoster and Postherpetic Neuralgia in Older Adults. NEJM 2005; 352: 2271-2284.

From CDC: Almost 1 out of 3 people in America will develop shingles during their lifetime. Your risk increases as you get older. People 60 years of age or older should get vaccinated against this painful disease.

© Post-Polio Health, Volume 29, Number 4, Fall 2013