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October 31, 2017

What you need to know about new recommendations for the shingles, mumps vaccines

Daily Briefing

    The Advisory Committee on Immunization Practices (ACIP) last week recommended a new shingles vaccine be preferred over an existing one and—in a first—advised adults ages 50 through 59 be vaccinated against the virus.

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    The committee's recommendations are not binding, but the Washington Post's "To Your Health" reports CDC typically follows the panel's guidance. If approved, the committee's recommendations could be published as policy as early as 2018.


    According to the "To Your Health," anyone who has had chickenpox has the varicella-zoster virus, which lies inactive in nerve tissue and can resurface as shingles. The virus—which affects about one million U.S. residents each year—causes a painful rash on an individual's face or body, occasionally leading to strokes, spinal cord injuries, loss of vision, and encephalitis. The virus' most common complication among those 50 years or older is post-herpetic neuralgia, or nerve pain.

    The latest vaccine—GlaxoSmithKline's Shingrix, which garnered FDA approval earlier this month—is the first new shingles vaccine to get approved in 10 years, "To Your Health" reports. According to "To Your Health," the vaccine's most common side effects include swelling at the injection site, muscle pain, headache, and fever, all of which can last up to three days.

    GlaxoSmithKline said the two-dose vaccine will cost about $280, "To Your Health" reports. While insurers have not yet agreed to cover the cost of the new vaccine, insurers have typically covered shingles vaccines in the past.

    Recommendation of Shingrix

    The committee on Wednesday recommended Shingrix for adults ages 50 through 59, as well as anyone previously vaccinated against the virus with Merck's single-shot shingles vaccine, Zostavax. According to "To Your Health," the recommendation marks the first time the committee has recommended adults ages 50 through 59 be vaccinated against shingles. Previously, the committee recommended shingles vaccination for those ages 60 and older.

    Overall, the new recommendations would apply to about 62 million Americans, "To Your Health" reports.

    In an 8-to-7 vote, the committee also recommended Shingrix be preferred over the existing Zostavax vaccine. The committee in its vote cited data showing that Shingrix is:

    • 97 percent effective against shingles for people 50 through 59 years old, compared with 70 percent effectiveness for Zostavax;
    • 97 percent effective for people in their 60s, compared with about 64 percent effectiveness for Zostavax;
    • 91 percent effective for those in their 70s, compared with 41 percent effectiveness for Zostavax; and
    • 91 percent effective for those in their 80s, compared with 18 percent for Zostavax.  

    In addition, the committee cited research showing that Shingrix is also 91 percent effective in preventing nerve pain. The new vaccine's efficacy remains high four years post-vaccination, although data are sparse on its efficacy among those who've received just one of the two recommended doses. In comparison, Zostavax is about 67 percent effective against severe nerve pain within the first four years post-vaccination, and its efficacy drops after the first year and is virtually non-existent within nine years.

    A close vote

    Nancy Bennett, chair of the committee and a professor of medicine and public health at the University of Rochester, said the vote on the preferential recommendation was "certainly the closest vote in my experience at ACIP."

    Those who supported Shingrix' preference over Zostavax cited data showing it delivers better, longer-lasting protection against the virus. "Based on the information I have seen … how would you explain not advising someone get a vaccine that is expected to prevent serious disease more effectively than another product?" Jeff Duchin, a health officer in Seattle, said.

    Meanwhile, those in the panel who voted against Shingrix' preference over Zostavax cautioned that while the data show the new vaccine is more effective than the old one, there was a lack of data on how the vaccine performed among minority groups and in a non-clinical setting. "It's never been given outside [of] a research setting," said Cynthia Pellegrini, the SVP for public policy at the March of Dimes.

    In addition, those opposed noted that the vaccine requires two doses, compared with Zostavax's single dose, "To Your Health" reports.

    Ultimately, Kathleen Dooling, a medical officer with the CDC, said the recommendation "represents a major advance for people who want to be protected against the disease and its complications." However, she cautioned that Shingrix "also causes more reactions than they may be used to with other adult vaccines. … All indications are these are not dangerous to one's health, but they may interfere with your daily activities for a few days."

    Mumps vaccine recommendation

    In related news, the committee in a unanimous vote recommended that providers administer a third dose of the mumps vaccine when an outbreak occurs.

    According to "To Your Health," the recommendation follows an increase in mumps outbreaks since 2006, including more than 6,000 cases of mumps last year, the most in 10 years. Many of the outbreaks occurred among highly vaccinated college students, with more than half of the 150 reported outbreaks occurring in 2017 happening in university settings, "To Your Health" reports. 

    Latest recommendation

    Speaking at a ACIP meeting on Wednesday, officials said while CDC's current recommendations on the MMR vaccine—which guards against measles, mumps, and rubella—seems effective in controlling mumps in the general population, the vaccine's efficacy diminishes over time.

    The mumps portion of the vaccine has been shown to be 88 percent effective for those who have had two doses—traditionally administered between the ages of 12 and 15 months and again between the ages of four and six years—and 78 percent effective for those who have had one dose. However, the immunity provided by the vaccine can wear off over time, and evidence presented to the committee suggests that that could be the cause behind the recent outbreaks increase, "To Your Health" reports.

    In its announcement, the committee limited its recommended third dose to only those determined by public health officials to be at risk for mumps due to an outbreak of the disease (Sun [1], "To Your Health," Washington Post, 10/25; Kaplan, New York Times, 10/25; Sun [2], "To Your Health," Washington Post, 10/25).

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