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

The varicella zoster virus causes chickenpox in children, then lurks in the body for years and can cause painful shingles later in life.
James Cavallini
Science Source
The varicella zoster virus causes chickenpox in children, then lurks in the body for years and can cause painful shingles later in life.

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 2021 NPR. To see more, visit https://www.npr.org.

Award-winning journalist Patti Neighmond is NPR's health policy correspondent. Her reports air regularly on NPR newsmagazines All Things Considered, Morning Edition, and Weekend Edition.