- The Washington Times - Thursday, June 2, 2005

Trial offers hope for older patients with weakened immune systems

An experimental shingles vaccine prevents about half of the chickenpox virus cases in older adults and results in milder episodes for those do who get the illness, results of a large national trial show.

Most people get chickenpox as children and endure a week or so of fever and itchy blisters brought on by the varicella-zoster virus, a member of the herpes family. After chickenpox runs its course, it retreats to clusters of sensory nerve cells, usually located near the spinal cord, where it persists in a dormant state.

As the infected person’s immune system weakens with age, the virus can reactivate, multiplying and damaging sensory nerve cells to cause pain and then emerging on the skin in a blistery rash called shingles.

An estimated 600,000 to 1 million Americans are diagnosed with shingles every year, most of them older than 60. Pain and numbness from the nerve damage can persist for years, and in rare cases, can damage the eyes or internal organs.

“For some people, shingles can result in months or even years of misery,” said Dr. Michael Oxman, an infectious disease specialist at the Veterans Affairs San Diego Healthcare System and the University of California-San Diego who led the study reported today in the New England Journal of Medicine.

The vaccine trial “is very promising news for older persons,” said Dr. Stephen Straus, an infectious diseases specialist at the National Institute of Allergy and Infectious Diseases, which collaborated with the VA on the 5-year study. “They indicate for the first time that we can use a vaccine to prevent shingles.”

Since 1995, millions of American children have been protected from chickenpox with a zoster vaccine. The vaccine used for the older adults is a new, more potent version of the same vaccine made by the Merck Cop.

For the study, carried out in 16 VA medical centers and six medical facilities outside the VA, more than 38,500 men and women 60 and older received either a single injection of the zoster vaccine or a placebo. Neither the researchers nor the patients knew who got the real vaccine until the study was finished.

During an average of more than three years of follow-up, the vaccine reduced the incidence of shingles by 51 percent: 642 cases of shingles were diagnosed in the placebo group but only 315 in the vaccinated group. Overall, the burden of pain and discomfort was 61 percent lower for the vaccinated group than for those getting the placebo. The shots generally were well-tolerated, with few serious adverse events.

Doctors can use antiviral medications to speed the healing of shingles and reduce severity of nerve damage, but these are effective only if the drugs are used within 72 hours of the first sign of shingles rash.

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