CDC announces Shingrix as preferred vaccine to prevent shingles

Article written by Weston Malek

In our last post, we gave a brief overview of shingles and how Zostavax has been the primary prevention method for the past decade. Now, we’ll discuss the latest development in shingles prevention: the herpes zoster subunit vaccine, Shingrix®.

On October 25, 2017, the Center for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) announced endorsement of a new shingles vaccine, Shingrix, as the preferred vaccine to prevent shingles and shingles-related complications in adults 50 years and older. This marks a shift in current shingles vaccination policy in that Zostavax is no longer recommended as the standard prevention method. Additionally, adults age 50-59 years old who previously were at risk of developing shingles but not eligible for vaccination may now be protected.

Shingrix is a recombinant subunit vaccine given as a 2-dose series. It contains a combination of glycoprotein E, a herpes zoster virus (HZV) surface protein, and AS01B, an adjuvant suspension comprised of a purified soap bark tree extract (referred to as QS-21) and a Salmonella minnesota endotoxin fragment (monophosphoryl lipid A or MPL). This adjuvant mixture augments the immune system’s response to glycoprotein E, improving its ability to recognize and challenge to HZV reactivation before it can cause shingles. As a result, Shingrix was more than 90% effective in preventing shingles occurrence in clinical trials. The most common side effects to Shingrix were typically mild and common to receiving any vaccination: pain/inflammation at the injection site, muscle pain, tiredness, headaches, fever, and upset stomach.

The reason Shingrix has so quickly been adopted as the preferred shingles vaccine is because of how substantially it outperforms Zostavax. While Shingrix is more than 90% effective in preventing shingles rash, Zostavax is only 51% effective. Adequate protection lasts more than 4 years with Shingrix. By comparison, protection rapidly wanes after Zostavax immunization, with only about 20% of people still protected after 4 years. Likewise, Zostavax efficacy rates decrease with age – at the same time as the risk of shingles increases. Shingrix, however, appears to be effective in any age group. Perhaps the most important difference besides improved efficacy is the fact that Shingrix is a non-live, recombinant subunit vaccine while Zostavax is a live attenuated vaccine. While ACIP has not yet made an official statement recommending Shingrix for those who are immunocompromised, a non-live vaccine significantly reduces the concern for complications that prevents those with weakened immune systems from getting Zostavax.

In fact, the advantages of Shingrix are so impressive that ACIP has gone so far as to recommend that adults previous vaccinated with Zostavax should also receive Shringrix. Including these people and adults 50-59 years old who will now be eligible for shingles vaccination, a total of about 62 million Americans are recommended to receive Shingrix. But, for now, those individuals will have to wait: Shingrix is not expected to be available to the public until early 2018. Even then, it may take longer for insurance to begin covering Shringrix – though ACIP anticipates that it will be covered, just as Zostavax is currently.

 

References

  1. GlaxoSmithKline. CDC’s Advisory Committee on Immunization Practices recommends Shingrix as the preferred vaccine for the prevention of shingles for adults aged 50 and up [press release] (2017 Oct 25) [cited 2017 Nov 29]. Available from: https://www.gsk.com/en-gb/media/press-releases/cdc-s-advisory-committee-on-immunization-practices-recommends-shingrix-as-the-preferred-vaccine-for-the-prevention-of-shingles-for-adults-aged-50-and-up/
  2. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Hamborsky J, Kroger A, Wolfe S, eds. 13th ed. Washington D.C. Public Health Foundation, 2015.
  3. Shingrix [package insert]. Research Triangle Park (NC): GlaxoSmithKline LLC; 2017.
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New vaccine could help protect against shingles

Article written by Weston Malek

Almost 1 in 3 Americans will suffer from a severely painful condition as a result of a vaccine-preventable disease at some point in their lifetime. About 1 million cases occur in the United States each year, the majority in people over 60 years old. The disease with these alarming rates: shingles.

Shingles (also referred to as herpes zoster) is a painful, itchy, blistering rash that often develops in a stripe on one side of the body or face. Even though this rash typically clears up within a few weeks, the burning or stabbing pain can last for weeks to months after. This is called post-herpetic neuralgia (PHN) and the risk of developing PHN increases with age, especially in people over 60 years old. PHN alone can be debilitating, but shingles can also have other complications leading to vision problems or blindness.

The virus that causes shingles, varicella zoster virus (VZV), is the same virus that causes chickenpox. Most adults – and almost everyone born in the U.S. before 1980 – have been exposed to the virus, even if they do not remember ever having chickenpox. Shingles results from a reactivation of the virus later in life due to a weakening of the immune system with age, due to medical conditions that compromise the immune system (such as leukemia or HIV), or due to medications that suppress the immune system (such as steroids and other drugs used in rheumatologic disorders or after organ transplantation). People who had chickenpox younger than 18 months of age or who were exposed before birth are also at a higher risk of developing shingles.

Even though those at risk of shingles have already been infected with the virus, the best method of reducing shingles and PHN in adults is through vaccination. Since 2006, Zostavax® has been recommended for adults 60 years and older as a single-dose, live virus vaccine for shingles prevention. Zostavax reduces the risk of developing shingles by 51% and PHN by 67%. Unfortunately, people with weakened immune systems from medical conditions who are at the highest risk of developing shingles should not receive Zostavax because of the potential risk for complications from receiving a live virus vaccine. Additionally, shingles protection from Zostavax typically only lasts about 5 years, meaning that older adults will be at high risk again when immunity wanes.

On October 25, 2017, the Center for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) endorsed use of a new vaccine, Shingrix®, as the preferred vaccine to prevent shingles. Our next blog will discuss the advantages of Shingrix and why everyone over 50 years old should consider getting vaccinated.

References

1. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Hamborsky J, Kroger A, Wolfe S, eds. 13th ed. Washington D.C. Public Health Foundation, 2015.

2. GlaxoSmithKline. CDC’s Advisory Committee on Immunization Practices recommends Shingrix as the preferred vaccine for the prevention of shingles for adults aged 50 and up [press release] (2017 Oct 25) [cited 2017 Nov 29]. Available from: https://www.gsk.com/en-gb/media/press-releases/cdc-s-advisory-committee-on-immunization-practices-recommends-shingrix-as-the-preferred-vaccine-for-the-prevention-of-shingles-for-adults-aged-50-and-up/