At first, Phil Patterson, 69, thought it was an insect bite he got from working in the yard. But by the next day, he and his wife, Sandra, a retired nurse, knew it was more serious. The one raised, itchy bump had spread into a patch of bumps.
"It was all over the right side of his trunk, front and back," Sandra Patterson, 67, said.
The Newbury Park, Calif., couple soon learned that he was suffering from shingles, a viral infection that causes a painful rash that can flare up in anybody who has ever had chickenpox -- more than 95 percent of the population, according to medical experts.
Although there is a shingles vaccine, approved in 2006 by the U.S. Food and Drug Administration, only about 10 percent of people who should get it are being vaccinated, according to a federal Centers for Disease Control and Prevention survey released in late 2010.
The CDC estimates that about 1 million Americans each year develop shingles. The severity varies, but the pain can be so great that it can be life-altering, according to Dr. Bill Schaffner, president of the National Foundation for Infectious Diseases.
"It can turn people into hermits. Some people consider suicide because the pain is so great," Schaffner said. "It doesn't kill you, but it can profoundly alter your life."
So why aren't people getting the vaccine?
There are several obstacles, including limited public awareness. A 2010 survey by the National Foundation for Infectious Diseases found that 55 percent of Americans knew about the vaccine.
The CDC recommends that anyone 60 or older get the vaccine, but the foundation survey showed that just 16 percent of those aware of the vaccine knew it is recommended for people over 60.
Dr. Donnelly Wilkes, the family physician who vaccinated the Pattersons after Phil recovered, said most of his patients are unaware of the vaccine. But he thinks that's changing with the aging of baby boomers.
"By default, because we have such a rapidly growing geriatric population, people born in that era are bringing the issue to the forefront," he said.
People of any age can get shingles, but for people 60 and over, the symptoms are generally more serious, researchers say. The immunity developed from getting chickenpox as a child starts to wane.
"If you reach age 80, you have a 50-50 chance of experiencing at least one episode of shingles," he said.
And getting the disease once doesn't make you immune. A study published in the February issue of Mayo Clinic Proceedings showed that recurrences of shingles are more common than doctors originally believed.
"It's been thought that recurrences were limited to people with compromised immune systems, for instance, from chemotherapy or blood-borne malignancies, but this is not the case," said lead author Dr. Barbara Yawn, director of research at Olmsted Medical Center in Rochester, Minn.
The vaccine offers some protection. A study in the Journal of the American Medical Association this year showed that the vaccine prevented shingles in 76,000 patients in the Kaiser Permanente Health Plan more than 50 percent of the time.
But cost and availability of the vaccine can be an obstacle.
Merck & Co. Inc. is the only manufacturer of the drug, which is essentially a bigger dose of the chickenpox vaccine. Schaffner said Merck diverts a lot of the vaccine to childhood-immunization programs, leaving vaccines for shingles in shorter supply.
Schaffner was on the shingles-vaccine working group of the CDC's Advisory Committee for Immunization Practices. Because the vaccine can cost $200, the group tried to get it paid as part of Medicare Part B coverage when federal health-care reform was drafted. In the 11th hour, it became part of Medicare Part D, which is the prescription-drug program.
That means if you want to get the vaccine, you get a prescription, take it to your pharmacist and pay for it yourself, then wait until you are reimbursed.
"If you want to design a system for people not to get the vaccine, that's it," Schaffner said.
(Kim Lamb Gregory is a reporter for the Ventura County Star in California)