New Shingles Vaccine Could Reduce, Eliminate Virus and Symptoms

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• RAY SUAREZ:

  A new study out today in the New England Journal of Medicine found that an experimental vaccine cuts the risk of developing shingles by half. The vaccine was also found to reduce by two-thirds the incidence of chronic pain. The disease is contracted by about one million Americans each year.

  Here to walk us through the findings and their significance is the leader of the study, Dr. Michael Oxman. He is an infectious disease specialist at the Veterans Affairs San Diego Healthcare System.

  And, Dr. Oxman, just so people who haven't been exposed or known someone who is are clear about what we are talking about what it is, what is herpes zoster or shingles?

• DR. MICHAEL OXMAN:

  Well, shingles is a virus infection of nerves and skin that's caused by the same virus that causes chicken pox, because when you and I had chicken pox, and basically every adult who has grown up in the United States has had chicken pox, the virus didn't go away. It entered the endings of nerves of the skin from the blisters and traveled up the nerves and established a lifelong permanent dormant silent infection in those nerve cells. And it looks as if it's the immunity that we have as a result of having chicken pox that keeps it from waking up.

  But as we get older, that immunity falls off. And at some point in time, the virus can wake up and it multiplies in nerve cells, which are located in little collections called sensory ganglia, on either side of the spinal chord, from the top of your neck all the way down to your tail bone. And it wakes up in one of those, it multiples in the nerves, kills nerve cells and then after a few days comes down to the skin, along the nerve the way it went up, and causes a rash that looks like shingles — except it's confined to the band of skin that is given sensation by nerves, from a particular collection of nerve cells from which it woke up.

• RAY SUAREZ:

  So this is something that plots along a broad continuum? Some people it's just a little uncomfortable and some people it's really pretty bad?

• DR. MICHAEL OXMAN:

  It, it varies. And as you get older, the risk of getting shingles goes up and the severity goes up. And the likelihood of having a lot of nerve damage and the most common complication that goes with the nerve damage, and that is continuing nerve-based pain that can continue long after the rash has healed — called postherpetic neuralgia, which is the most common, serious complication that you get from shingles — that's something that's seen predominantly in older individuals.

• RAY SUAREZ:

  So here you wanted to reinforce, reassert the immunity. You did the vaccine trial. Tell us how you did it and what you found.

• DR. MICHAEL OXMAN:

  Well, we vaccinated 38,546 adults 60 years of age and over. Half of them got one shot of the vaccine and half of them got placebo. And then we followed them actively, having them call an automated telephone system every month so that we kept track of them, and we worked very hard to detect and to, if you will, capture every case of shingles that developed during the study. And we were available seven days a week to diagnose and to provide treatment for that shingles. And then when that happened, we measured how bad the shingles was.

  And since pain is the main problem with shingles, we had developed a questionnaire that the patients answered and scored their pain from zero to ten, zero being no pain and ten being the worst pain you could imagine. And we did that repeatedly over a period of six months; and sort of the area under the curve, the height of which is the pain score and the duration was a measure of how bad the shingles was in each person who had it.

• RAY SUAREZ:

  So what'd you find?

• DR. MICHAEL OXMAN:

  We found that when we broke the code, if you will — it was a double-blind study — we found that, as you said before, the number of cases of shingles was reduced by 51 percent. And the ones that did develop in people who got vaccine, that was reduced in severity. So the average severity of the shingles in people who got vaccine was reduced.

  And then the overall burden of illness, the extent of the pain in the whole population of vaccinated people compared to the placebo group was reduced by 61 percent. And very importantly to older people, the chronic nerve pain that goes on for months or even years — that was reduced as measured by pain that went beyond 90 days — that was reduced by two-thirds.

• RAY SUAREZ:

  So these are pretty significant results. This is beyond the statistically soft…

• DR. MICHAEL OXMAN:

  Yes, this is pretty significant, particularly if — I'm 68; if you're in my class of age, where most of the severe shingles is, they're very significant results.

• RAY SUAREZ:

  Now, you mention the relationship to chicken pox. Now they're vaccinating children against chicken pox. Is this the same virus they're using?

• DR. MICHAEL OXMAN:

  It's the same virus, but because you and I had chicken pox and have a degree of immunity, it takes a heck of a lot more of that virus to boost our immunity than it does to vaccinate children. So the lowest dose of virus that was used in this study and the range of doses was at least 14 times more potent than the chicken pox vaccine used in children.

• RAY SUAREZ:

  Now, if the studies continue and this gets approved as a therapy, who would get the vaccine, people beyond a certain age or people who feel it coming on in order to prevent recurrence? How would this be used as a tool?

• DR. MICHAEL OXMAN:

  Well, half of the people who get to be 85 will have shingles once. And so this study was done in people who were 60 and over because that's where the risk of getting shingles and postherpetic neuralgia, the chronic nerve pain, really gets to be very significant. We know that that group of people is certainly a — certainly candidates. And about half a million of those million cases of shingles that occur every year in the United States occur in people who are 60 and over.

  So if we translated the study's results to the whole American population, you would eliminate a quarter of a million cases of shingles every year and reduce the severity of the other quarter of a million, the other 250,000 that still occurred. And since almost everybody who gets postherpetic neuralgia is over 60 — in other words, that's not something that's very common in 40-year-olds — you would really reduce postherpetic neuralgia, the chronic nerve pain, by about two-thirds.

• RAY SUAREZ:

  Dr. Oxman, thanks for being with us.

• DR. MICHAEL OXMAN:

  It's a pleasure. Thank you very much.