Panel recommends new, better shingles shot over old version

This image provided by GlaxoSmithKline in October 2017 shows the company's Shingrix vaccine. On Wednesday, Oct. 25, 2017, a federal panel of experts recommended that as many as 20 million Americans who were vaccinated against shingles get revaccinated with a new shot. The panel said doctors should first opt for Shingrix, licensed a week earlier, which uses a new ingredient to boost immunity. 

27 oct 2017--A federal panel recommended Wednesday that older people already vaccinated for shingles get a new, better shot.
The advisory group said the just-approved vaccine made by GlaxoSmithKline works better at preventing shingles and may last longer than the one that's been sold in the U.S. since 2006.
Shingles, a painful condition that causes blisters, occurs when the chickenpox virus resurfaces decades later, often when people are in their 60s or older. About 1 in 3 U.S. residents will get it during their lifetime, according to the Centers for Disease Control and Prevention.
At a meeting in Atlanta, the Advisory Committee on Immunization Practices said doctors should first opt for Glaxo's two-dose Shingrix, which uses a new ingredient to boost its effectiveness. It was approved in the U.S. last week, and the committee recommended it for adults 50 and older.
Shingrix has been shown to be 90 percent effective and last at least four years in company-sponsored studies.
"It performs in very superior fashion and will prevent more disease than the other vaccine available," said panel member Dr. Kelly Moore, director of the Tennessee health department's immunization program.
The vote recommending a preference for Glaxo's vaccine over Merck's single-dose Zostavax was unusually close, 8-7. Panel members noted that the two vaccines have not been tested head-to-head yet, and some wanted to wait for more long-term safety information about the new additive used by Glaxo.
But other panel members worried that without citing a preference, many doctors and pharmacies may decide to stock Merck's less expensive vaccine, which costs $232 compared to $280 for the Glaxo vaccination.
Merck's single-dose Zostavax vaccine is recommended for people 60 and older. It reduces the risk by about half, though health officials say its effectiveness drops sharply after about five years.
The panel didn't suggest a time frame when it recommended a Glaxo vaccine for anyone previously vaccinated. Health officials say as many as 20 million Americans would be eligible for a second round.
The shingles vaccine hasn't been very popular; only about 30 percent of those over 60 got it.
The panel's recommendations are almost always adopted by the CDC. But in a statement, Merck officials said they hope the agency will consider some of the issues raised at the meeting and not give a preferential recommendation to Shingrix

AGS: Shingles Vaccine Booster Is in the Cards after Four Years

SEATTLE, May 7 -- Immunogenicity from the live attenuated herpes zoster vaccine (Zostavax) -- unlike herpes -- is not forever, post-marketing data suggest.
Although the vaccine's protection lasts for at least four years, the data suggest that a booster shot may be needed for longer-term protection, said Kenneth Schmader, M.D., of Duke University at an industry-sponsored symposium held in conjunction with the American Geriatrics Society meeting here.
He noted that researchers have anticipated the need for a booster because the herpes vaccine is a super-potent formulation of the varicella vaccine, for which recent studies have confirmed a pattern of fading protection.
Dr. Schmader was a co-investigator of the pivotal Shingles Prevention Study that led to FDA approval of the herpes zoster vaccine and is a member of the CDC's Advisory Council on Immunization Practice (ACIP) working group on the vaccine.
The vaccine was approved for prevention of herpes zoster and postherpetic neuralgia in people ages 60 or older.
Rafael Harpaz, M.D., M.P.H., acting chief of the herpes virus team at the CDC, said clinicians should assess requests for the vaccine on a case-by-case basis, but added that it was unlikely that the vaccine would offer a benefit beyond the natural protection offered by infection with wild type herpes zoster.
Last fall the vaccine advisory council approved a provisional recommendation that endorsed use of the vaccine for persons age 60 or older "whether or not they report a prior episode of herpes zoster."
In an interview, Dr. Harpaz said the final ACIP recommendation was on his desk and was scheduled for release this fall. He said he did not anticipate any major changes from the provisional recommendation.
Asked about number needed to treat and cost-effectiveness of the vaccine, Dr. Schmader said the American College of Physicians' journal club calculated that one case of herpes zoster would be prevented for every 55 people vaccinated and 350 immunizations were needed to prevent one case of postherpetic neuralgia.
Dr. Harpaz said the CDC has attempted a number of analyses, but "the cost effectiveness has varied from $18,000 to $105,000 per case averted, so it is just too hard to nail down a figure."
Paying for the vaccine has been a problem for Medicare patients, Dr. Schmader acknowledged at the Merck-funded event, because of the coverage mechanics of Medicare Part D.
The risk of herpes zoster -- and postherpetic neuralgia -- increases exponentially after age 60, noted Michael Oxman, M.D., chief of infectious diseases at VA Medical Center, San Diego and principal investigator of the Shingles Prevention Study.
Data from that study suggest that universal vaccination of all Americans age 60 or older would eliminate just over half of the estimated 556,000 herpes zoster cases per year, Dr. Oxman added, and more than two-thirds of the cases of postherpetic neuralgia.
The use of the vaccine in people younger than 50 remains unanswered, said Dr. Oxman.
"It's an off label use, but if I have a faculty member's wife who is 53 and has had an episode of herpes zoster and wants the vaccine -- and is willing to pay for it -- I am probably going to give it to her," Dr. Oxman said. "But I'm going to explain that she will probably need a booster shot."