Zoster Vaccine Quiz: How are We Doing?

[[{"type":"media","view_mode":"media_crop","fid":"50195","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_9615488932467","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6112","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 237px; width: 300px; float: right;","title":"Shingles, C8 nerve distribution ","typeof":"foaf:Image"}}]]As a general pediatrician, I see a case or two of shingles every year. My adult colleagues probably see that many every month. The incidence in adults is about 4 per 1000 patients per year. While pediatricians may see the occasional child with shingles, what we never see is a subsequent case of post herpetic neuralgia (PHN) which is rare in persons under the age of 40.

Over the age of 60, more than 13% of individuals who get shingles will suffer from PHN. This painful, sometimes even debilitating condition at the site of the resolved rash can last commonly for weeks and occasionally for years.         

Zostavax is the only vaccine approved for use to reduce the risk of shingles in vaccine recipients. In this Part 1 quiz, let’s see what you know about our current shingles vaccine. In a follow-up article, we’ll talk about a new one in the pipeline.

1. Which of the following is true about Zostavax?

A. The vaccine is a live attenuated one made differently from the current live chickenpox vaccine.

B. The vaccine is made the same way as the current chickenpox vaccine, but has a four-fold increase in the amount of injected antigen as compared to Varivax, the current chickenpox vaccine.

C. The vaccine is made the same way as the current chicken pox vaccine, but has a fourteen-fold increase in the amount of injected antigen as compared to Varivax, the current chicken pox vaccine.

D. The vaccine is an inactivated one using a glycoprotein on the surface of the varicella virus combined with an adjuvant designed to stimulate the T cell component of the immune response.

For answer, discussion, and next question, please click here.

Image courtesy of Robert P. Blereau, MD

Answer: C. … has a fourteen-fold increase in the amount of injected antigen vs Varivax …

When Merck first introduced Zostavax in May 2006, the company had to temporarily stop making Proquad, a combination of 4 doses of Varivax combined with MMR for use in children. Merck simply could not make enough attenuated varicella virus to make all three of these varicella virus-containing vaccines.

How well does Zostavax work in preventing shingles? In persons older than age 60, the vaccine’s overall effectiveness is about 50%. In the cohort aged 60 to 69, the effectiveness is 64% and drops with increasing age. After age 80, effectiveness is about 18%.

2. What is the impact of the vaccine on the development of PHN in vaccine recipients who develop Zoster anyway?

A. There is no reduction seen  

B. About a 5% reduction

C. About a 20% reduction

D. About a 50% reduction

For answer and discussion, please click here.

The correct answer is B. About a 5% reduction

Overall, the vaccine recipients have a reduced amount of PHN mainly because they are less likely to develop shingles. Nor does giving someone with PHN a dose of Zostavax have any impact on the disease.

As Terry Bradshaw implies in the network television commercial for Zostavax, a man his age is better off vaccinated against shingles than not. At the same time, the one vaccine we have leaves room for improvement. In part 2 of this segment we will consider other features of the vaccine and take a first look at another product in development that, so far, promises greater efficacy. As for Terry, he may need to “pass” on his current role as spokesman for Zostavax if the new vaccine works out as well has hoped.

Resources

A good overview of shingles. http://www.cdc.gov/shingles/hcp/clinical-overview.html 

This shows the incidence of shingles in children to be about a tenth of that of adults. http://www.ncbi.nlm.nih.gov/pubmed/19773676

A nice overview of shingles, PHN, and the vaccine. http://www.fda.gov/BiologicsBloodVaccines/Vaccines/QuestionsaboutVaccines/ucm070418.htm

This describes who should and who should not get the shingles vaccine. http://www.fda.gov/BiologicsBloodVaccines/Vaccines/QuestionsaboutVaccines/ucm070418.htm

Discusses the modest reduction in PHN in vaccine failure patients. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664599/