Vicki Yeomans can instantly sense when she’s in for a bout of misery. It starts with a hard-to-describe feeling of anxiety that affects her whole body. Then it hits her: the urge to urinate, the burning pain and the feeling that, no matter how frequently she visits the bathroom, she can’t empty her bladder.
“It’s kind of gross to say, but people say you feel like you’re peeing razor blades,” she said. “It’s that searing pain.”
An estimated half of adult women will experience more than one urinary tract infection in their lifetime. Ms. Yeomans is among the 3 per cent of women who suffer from recurrent UTIs, which occur multiple times a year. She estimates she gets them as often as once every three weeks.
But until August, for a merciful stretch of about a year, the 68-year-old Kingston resident got a temporary break from those persistent, agonizing infections. It was the first time in a decade she was free to go about her life, without taking antibiotics or worrying about having to be near a lab to get tested to receive the drugs. The remedy? A vaccine, administered by spraying a liquid under the tongue, that is now awaiting Health Canada approval.
The vaccine, called MV140, which Ms. Yeomans received as part of a study, is one of several that scientists are researching for UTIs. Their efforts to make a vaccine available to patients has become all the more urgent, as antibiotics, which are currently the only treatment, lose their efficacy owing to growing bacterial resistance.
“We’re getting a lot of these infections that are resistant to antibiotics, and the antibiotic pipeline is drying up rapidly,” said Curtis Nickel, professor emeritus in the department of urology at Queen’s University and Kingston Health Sciences Centre, who led the Canadian research on MV140. “This is sort of the dark ages of the antibiotic golden era, and it’s very concerning.”
UTIs are caused by one of several types of bacteria, E. coli being among the most common. Although certain male populations, such as those with prostate issues, are at risk of UTIs, they tend to occur in women, particularly those in their late teens and early 20s who are sexually active, and after menopause, since the decline in estrogen leads to changes in vaginal flora, said Mélanie Aubé-Peterkin, an assistant professor in urology at the McGill University Health Centre, who is not involved in Dr. Nickel’s research.
For those who get recurrent UTIs, doctors can prescribe what’s called prophylactic antibiotics, a regular low dose to suppress infections, or post-coital prophylaxis, where antibiotics are taken right after sex, she said. But besides the risk of bacterial resistance, antibiotic use can carry the risk of complications, including vaginitis, thrush and colitis. Dr. Aubé-Peterkin explained other prevention measures, such as cranberry capsules and lactobacillus probiotics, have limited efficacy and can be quite expensive, and are not usually covered by provincial health care.
The move to allow pharmacists to prescribe drugs for UTIs in some jurisdictions can help reduce the burden of these infections on emergency department visits and doctor’s visits, Dr. Nickel said. Since January, Ontario pharmacists have been able to prescribe medications for minor ailments, including UTIs, and those in B.C. will be able to do so in March. But this doesn’t reduce the amount of antibiotics that are used for treating them in Canada.
“The real objective would be to prevent these infections with sort of a safe and effective intervention,” he said.
To that end, Dr. Nickel sought to bring MV140, a UTI vaccine developed in Spain by the pharmaceutical company Inmunotek, to Canada. It is one of a few UTI vaccines, along with Uro-Vaxom, that are already used in other countries. MV140, marketed under the brand name Uromune, is available to patients under special access programs in Australia, New Zealand and several countries in Europe and Asia, Dr. Nickel said, which means doctors can’t readily prescribe them, but must follow special criteria for approved use.
While Health Canada declined Dr. Nickel’s request for similar special access authorization to use the drug for his patients here, it allowed him to set up a study to test it on a group of them in Kingston, including Ms. Yeomans.
The vaccine contains several types of inactivated bacteria that commonly cause UTIs. By spraying it under the tongue daily over three months, very sensitive immune cells detect the dead bacteria and train the immune system, sending signals to other mucosal surfaces, including in the bladder, urethra and vagina, to produce an immune response to them. When the vaccine is taken daily over three months, these mucosal surfaces defend against infection.
An international study he co-authored of 240 women with recurrent UTIs, published in The New England Medical Journal in 2022, found 56 per cent of participants who received MV140 for three months were free of UTIs, compared with 25 per cent who were treated with a placebo.
Dr. Nickel’s pilot study in Kingston found 40 to 50 per cent of the 67 participants stopped having UTIs, he added.
It’s yet unknown how long the protection lasts. Ms. Yeomans’s infections returned after a year. She’s back on antibiotics, but hopes to receive another course of the vaccine since she’s worried antibiotics may eventually stop working for her.
The health care company Red Leaf Medical, which holds the licence for MV140 in Canada, filed for Health Canada approval of the vaccine in March, 2022. Its executive director of corporate affairs Janet Ko said the vaccine is now under active review, a process that typically takes a year or two.
Meanwhile, researchers at several U.S. universities are at various stages of developing new UTI vaccines. Joel Collier, a professor of biomedical engineering, is working on one of two being developed at Duke University. In a recent study published in the journal Science Advances, Dr. Collier and his colleagues showed their vaccine, which comes in the form of a tablet that dissolves under the tongue, was as effective as antibiotics at protecting mice from UTI-causing E. coli.
They are now exploring the experiments needed to advance their work toward a clinical trial, he said.
For Dr. Nickel, all of these developments provide hope that relief for his patients is on the horizon.
“I really wish I was at this point in my career like 10, 15 years ago because this is going to lead to more exciting vaccines for infections,” he said. “It’s just the cusp of what is coming.”
Editor’s note: An earlier version of this story included incorrect spelling of the pharmaceutical company Inmunotek, and stated an incorrect number of women who participated in the vaccine trial. This version has been corrected.