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Feature Story

Research into Shingles is Key to Prevention

By Dani K. Dodge Medlin

November 14, 2013

Hung Fu Tseng, PhD, MPH, of the Kaiser Permanente Department of Research & Evaluation in Pasadena, Calif.

A decade ago, people could do little to prevent shingles, a viral disease that primarily strikes the elderly. The disease can cause pain, rash, and in some cases, impaired vision.

In 2005, initial clinical trials showed great promise for a vaccine, which used a live virus to prevent shingles. Three years later, the Centers for Disease Control and Prevention officially published a recommendation that people age 60 years and older get the vaccine. But it didn’t take off. Many people were wary of the vaccine. Others hadn’t heard about it.

“Many questions about the vaccine remained unanswered when it was first introduced to the public,” said Hung Fu Tseng, PhD, MPH, of the Kaiser Permanente Department of Research & Evaluation in Pasadena, Calif. “This was the first live virus vaccine recommended for older adults, and we didn’t know too much about its safety or effectiveness in general elderly population.”

Kaiser Permanente and real world research
So Dr. Tseng and the Department of Research & Evaluation’s vaccine team — along with researchers from the CDC, including Stephanie R. Bialek, MD, MPH, leader of the unit responsible for monitoring the virus that causes shingles at the CDC’s Division of Viral Diseases — began their quest for answers.

Dr. Bialek said one of the benefits of working with Research & Evaluation on vaccine effectiveness was Kaiser Permanente Southern California’s large, diverse membership, which is representative of the population and provides a great snapshot of how the vaccine works in the “real world.”

Shingles related to childhood chickenpox
Shingles occurs when the virus that causes childhood chickenpox is reactivated. Nearly all adults have the virus that causes shingles, also known as herpes zoster. As a result, adults have a 1-in-3 chance of developing shingles at some point in their lives.

When reactivated in adulthood, the virus can, if severe, cause debilitating pain and a rash. In 10 percent to 25 percent of cases, the virus attacks an eye and can permanently impair vision. People often notice the pain first.

“That pain is usually associated with a rash,” said Bruno Lewin, MD, a family medicine physician at the Los Angeles Medical Center who is currently working with Dr. Tseng on shingles research program. “However, that pain is variable. Some people may just say it is a strong pain, while others say it is sharp, burning or a stabbing feeling. It can often be debilitating.”

Vaccine reduces shingles by more than half
Knowing that the discomfort could be prevented in many cases, Dr. Tseng and his colleagues are working on a series of studies to solve questions about shingles and the vaccine.

The first study Dr. Tseng led showed that people who received the shingles vaccine had a 55 percent reduced risk of developing shingles. Published in the Journal of the American Medical Association in 2011,it was the first large-scale effectiveness study of the vaccine. More than 400 media outlets picked up the story including the New York Times, Los Angeles Times and USA Today.

A subsequent study of Dr. Tseng’s, through the Vaccine Safety Datalink and funded by CDC’s Immunization Safety Office, showed the vaccine was generally safe, with only a small increased risk of allergic reactions one to seven days after vaccination. It was published in the Journal of Internal Medicine in May 2012.

“I was really pleased to be able to provide important insights from various angles because if it was an effective product, the elderly population should be aware of its existence and talk with their doctors about whether they should get it or not,” Dr. Tseng said.

Research is one element to shingles prevention
The research has begun to change people’s opinions, and knowledge, of the vaccine.

“There are different ways that you can encourage vaccine usage,” Dr. Lewin said. “And if you are talking about a live vaccine, it’s very important to let people know it’s safe and effective. This research goes a long way to overcoming the patient reluctance. The science behind the vaccine can be powerful and helpful.”

Six more Kaiser Permanente Southern California studies followed including those showing:

More research to be done
Dr. Tseng said he was gratified to see the vaccination numbers are increasing among Kaiser Permanente Southern California members, but that much work still needs to be done. He is currently working on several other studies focused on the shingles vaccine including one that explores why the shingles virus activates in some people but not others. Another study seeks to determine the vaccine’s effectiveness in combating lingering pain — one of the most damaging and lasting complications of the disease.

While people age 60 years and older can face many health challenges, Dr. Bialek of the CDC agrees it will be important to continue research into shingles.

“Shingles can be very severe for some people. We have no idea who will get the most severe form,” Dr. Bialek said. “Fortunately, there is a vaccine that can prevent it.”