Engineering A Shingles Vaccine That Doesn't Wimp Out Over Time

Jul 13, 2015
Originally published on July 14, 2015 5:32 pm

If you had chickenpox as a child, then you're at risk for shingles. As you age, the risk increases, probably because the immune system weakens over time.

The varicella zoster virus can hide in the body over a lifetime and suddenly activate, causing a painful, blistery rash. Even when the rash disappears, pain can linger and worsen, causing a burning, shooting, stabbing pain so severe it can leave people unable to sleep, work or carry on other activities.

There is a vaccine on the market. The Centers for Disease Control and Prevention recommends it for people age 60 and older. But it's not very effective. It prevents shingles 64 percent of the time overall, but loses effectiveness as years go by, just when people are getting more susceptible. By the time people turn 70, the vaccine is only 38 percent effective.

A new vaccine that offers nearly complete protection against the painful shingles rash may be on the market as early as 2017.

The vaccine, developed by the pharmaceutical company GlaxoSmithKline, has proved to be effective more than 97 percent of the time regardless of age, says Dr. Leonard Friedland, GSK's director of scientific affairs and public health. That study involved more than 16,000 patients age 50 and older, with some patients well into their 80s. The high degree of efficacy was there for all ages, Friedland says.

What's different about this vaccine is something called an adjuvant — a chemical added to the vaccine with the sole job of "waking up" the immune system. The technology has been used in other vaccines, but not for shingles. Researchers are now looking at the potential for adjuvants in vaccines for older adults, says Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center.

As people age, so does their immune system. Having something to help the body respond better to the vaccine and offer more protection, "that's dynamite," says Schaffner.

But the biggest challenge may be getting older people vaccinated in the first place, according to Dr. Susan Rehm, an infectious disease specialist at the Cleveland Clinic. Even though shingles vaccine is recommended for everyone over the age of 60, only 24 percent actually get the vaccine. "That is a low number," Rehm says. "Unfortunately it's typical of many adult vaccines; we find that adults are very much undervaccinated."

That's partly because adults, unlike children, don't have regularly scheduled doctor visits to receive vaccinations. Another barrier is cost. The current vaccine costs $200 or more. Medicare covers the cost for people over 65, but payment can be complicated. Most private plans cover it, but not all of them, so some patients may have to pay the full price themselves and hope for reimbursement.

And if you're between 50 and 59, when the risk of shingles begins to increase, you'll likely have to cover the full cost, even if you have insurance. That's because while the FDA has approved the vaccine for people over 50, the CDC only recommends it for people over 60, and that's the guideline most insurance companies use.

It's not clear what the new, more effective vaccine will cost. GSK officials expect to submit data to the FDA for approval sometime in 2016, with hopes of putting the vaccine on the market by 2017.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.

Transcript

DAVID GREENE, HOST:

If you had chickenpox as a child, you are at risk for shingles. That virus can hide in the body over a lifetime. And, for reasons that are still not completely clear, the virus can suddenly activate causing a painful, blistery rash. A shingles vaccine is available, but it wears off over time. In Your Health this morning, hope for a new, more effective shingles vaccine. Here's NPR's Patti Neighmond.

PATTI NEIGHMOND, BYLINE: The pain from a shingles rash can be severe. But it's the pain that lingers long after the rash goes away that can be really debilitating. Dr. Leonard Friedland is a vaccine researcher.

LEONARD FRIEDLAND: It can cause burning and shooting and stabbing pains. People can't sleep well. They can't work.

NEIGHMOND: As people age, the risk of shingles increases. Health officials recommend people over 60 get the vaccine. It prevents two thirds of shingles cases. But effectiveness wears off over time, and that's why the pharmaceutical company Friedland works for, GSK, decided to develop a new vaccine. It's 97 percent effective regardless of age.

FRIEDLAND: So be it 50 to 60, or 60 to 70, or 70 or older - this high degree of efficacy was there for all ages, and this is the first time this has been seen for any vaccine to prevent shingles.

NEIGHMOND: What's different about the new vaccine is something called an adjuvant - a chemical added to the vaccine with the sole job of waking up the immune system. And that makes a big difference for older people, says Dr. William Schaffner, an infectious disease specialist at Vanderbilt Medical Center.

WILLIAM SCHAFFNER: As individuals age, just as they become more physically frail, so does their immune system. So to have this adjuvant kind of kick start the immune system so that it responds better to the vaccine and makes better protection, that's a real innovation.

NEIGHMOND: It's not a new technology, but Schaffner says it's likely to be used more in vaccines as the population ages and still needs protection against diseases like shingles and the flu. But the challenge may be getting older people vaccinated in the first place, says Dr. Susan Rehm, an infectious disease specialist at the Cleveland Clinic.

SUSAN REHM: When we talk about shingles vaccine, I would have to say - oh, gosh, maybe 50-50. Some people know about it, some people vaguely know about it, and surprisingly many don't know about it at all.

NEIGHMOND: And even though the vaccine is recommended for people 60 and older, only 24 percent actually get it.

REHM: And that is a low number, but it unfortunately is typical of many adult vaccines. We find that adults are very much under-vaccinated.

NEIGHMOND: One barrier could be cost. The vaccine now on the market runs about $200 or more. Most private insurers pay for it, but some don't. And if you're between 50 and 59 when the risk of shingles begins to increase, you may have to pay the full price yourself even if you have insurance. It's not clear what the new, more effective vaccine will cost. It's still in the research phase and probably won't be approved and available for at least a year. Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.