A Shot at Better Health Two New Vaccines Now Available To The Public

by Susan Williams

Two new vaccines, which will be of interest to large portions of the population, have recently become available to the public. These newly developed vaccines, both developed by pharmaceutical giant Merck & Co., can help protect against shingles infections and most cases of cervical cancer.

Shingles

Shingles is a painful viral infection that is caused by herpes varicella-zoster, the same virus that causes chickenpox. The pain from shingles can be quite severe as the virus infects the nerves in the body. Sufferers also experience a blistering rash that can scar the skin, and some continue to have persistent pain long after the infection clears up. This chronic pain, known as post-herpetic neuralgia, can be debilitating and there is currently no cure.

After a chickenpox infection, the virus becomes dormant and remains in the body. While some people may never experience any further symptoms, sometimes the virus can become reactivated and cause a shingles infection.

Though the cause for reactivation of the virus is usually unknown, it sometimes occurs when a person's immunity has been reduced or suppressed. This occurs fairly often, and the National Institutes of Health estimates that 500,000 Americans will develop a shingles infection this year alone. Most of those cases will occur in people over the age of 60.

Although a single episode of shingles usually provides a person with lifelong immunity from further attacks, a rare few may have repeated episodes. There is currently no drug that can eliminate the virus completely, although anti-viral drugs may help shorten the duration of a shingles attack. Doctors hope to reduce the numbers of shingles cases thanks to a new vaccine that is now available.

The new vaccine, known as Zostavax, is the result of nearly two decades of research. Zostavax is a live but weakened form of the varicella-zoster virus strain. It is administered subcutaneously as a single shot and is 14 times more potent than the vaccine used against chickenpox. Merck says the new vaccine works by boosting the immune system’s ability to suppress the virus in nerve roots.

The catalog price for Zostavax is $145.35. Zostavax is scheduled for coverage under Medicare's Part D prescription program, and may already be covered by some health insurance plans.

The Zostavax vaccine was studied in 38,000 American seniors who were monitored for three years. Half received the vaccine while the rest received a placebo. In adults ages 60 to 69, the vaccine reduced outbreaks of shingles by 64 percent. Even among those individuals who developed shingles, the vaccine reduced the duration and severity of pain.

Zostavax has been FDA approved for those age 60 or older who have had chickenpox and who do not have a compromised immune system. Although some doctors may be tempted to offer vaccinations to adults age 50 to 59 in hopes of providing earlier protection against shingles, they should be aware that the vaccine has not been studied in such patients.

Cervical Cancer

Cervical cancer is one of the most common cancers among women. Approximately 10,000 women in the United States are diagnosed with cervical cancer each year, and the National Cancer Institute estimates that about 4,000 of those women will die. The rates are even higher in developing countries.

A perhaps little-known fact is that most instances of cervical cancer are caused by the human papillomavirus (HPV), which can be transmitted sexually. The new vaccine, known as Gardasil, will help protect women from this virus that causes approximately 70% of all cervical cancers. The vaccine is given as three separate intramuscular injections in the upper arm over a six-month period.

The catalog price for Gardasil is $360 ($120 per dose), and some health insurance companies have already agreed to cover the cost. The price may also decrease with competition, as a similar vaccine called Ceravix has been developed by GlaxoSmithKline and may be approved later this year. The federal "Vaccines for Children" program is expected to cover the cost of the vaccine for children who meet eligibility guidelines.

The Gardasil vaccine is recommended for all young females, generally those between the ages of 11 to 26. As the vaccine is most effective when given before contracting the virus, The Advisory Committee on Immunization Practices states that girls can be immunized even as young as 9 years old, at the discretion of their doctors. Some experts are also recommending it for young males, in whom it can help prevent genital warts and possibly penile cancer. Having both sexes vaccinated against HPV would also help to reduce the spread of the disease.

However, it is crucial that women who have been vaccinated continue to have an annual Pap smear, since the vaccine does not protect against viruses that are responsible for 30% of cervical cancers.

Merck’s four-year clinical trials involved about 20,000 women of all ages and in 13 different countries, including Brazil, Colombia, Denmark, Finland, Iceland, Mexico, Norway, Peru, Poland, Singapore, Sweden, the United Kingdom and the United States (including Puerto Rico). In the clinical study, the vaccine prevented 100 percent of HPV-related cervical pre-cancers and non-invasive cervical cancers, 95 percent of low-grade cervical dysplasia (low grade lesions) and pre-cancers, and 99 percent of cases of genital warts. Gardasil also prevented 100 percent of HPV-related vulvar and vaginal pre-cancers in women who had not previously been exposed to the relevant HPV types.

Although many believe that the first vaccine against cancer is something to celebrate, there is opposition from some conservative groups. "Giving the HPV vaccine to young women could be potentially harmful, because they may see it as a license to engage in premarital sex," Bridget Maher of the Family Research Council was quoted in New Scientist.

Upon hearing this, many expressed a similarly scornful reaction as this anonymous blogger on About.com, "The logic here is about as sound as saying 16-year-olds shouldn’t be allowed to use seatbelts because they might take that protection as license to drive recklessly." Aware that some people may not be able to afford the cost of these vaccines, Merck has initiated a new patient assistance program that provides free vaccines, including both Zostavax and Gardasil, to low-income adults who are uninsured.

The non-profit international health group PATH, with support from the Bill and Melinda Gates Foundation, is exploring ways to distribute Gardasil to women in developing countries worldwide.

As science continues to make progress in the development of protection against disease, it is important for individuals to remember the old adage that "an ounce of prevention is worth a pound of cure".