A New Vaccine to Protect Against Shingles

Paul A. Offit, MD


July 01, 2015

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Hi. My name is Paul Offit, and I am talking to you today from the Vaccine Education Center at the Children's Hospital of Philadelphia. I thought it would be interesting to talk about a new study[1] that was just published in the May 28, 2015, issue of the New England Journal of Medicine that looked at the efficacy of a new vaccine to protect against shingles.

This vaccine is made in a manner that is different from the current vaccine. The current vaccine is made by taking the chickenpox vaccine and using about 14 times the dose. It is a live, weakened form of the varicella virus. This new vaccine is different. It is a subunit vaccine. The investigators took the glycoprotein E of varicella-zoster virus. They used 50 µg of that and added two adjuvants. One was 50 µg of monophosphoryl lipid A, which is detoxified lipid A. It is actually the same adjuvant that is used in the current Cervarix vaccine, which is a vaccine made to protect against human papillomavirus. They also took 50 µg of another adjuvant, called QS-21, which is a derivative of saponin.

The investigators tested this vaccine prospectively in 15,000 older adults who were stratified by age: 50-59 years of age, 60-69 years of age, and older than 70 years. They looked at the acquisition of shingles in these three groups over about a 3-year period. They found that in the placebo group, there were about 210 cases of shingles, whereas the vaccine group only had six. That is an efficacy of about 97%. That efficacy was found in all three groups. That is phenomenally good and it is actually much better than the current vaccine.

There are two issues that still need to be resolved. The first is: What is the long-term protection or longer-term protection beyond 3 years in these groups? I think those data will be generated over time. The second issue, and probably the more difficult one, is: To what extent will we be able to extend the use of an adjuvant like QS-21 in the United States? Right now in the United States, there are only two adjuvants that are licensed for use. One is the aluminum salts and the second is monophosphoryl lipid A. Although the adjuvant QS-21 has been used in other countries, it hasn't been used routinely in this country. So we will see. These are certainly very promising data.


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