Cellular and Humoral Responses to a Second Dose of Herpes Zoster Vaccine Administered 10 Years After the First Dose Among Older Adults

Levin, Myron J.; Schmader, Kenneth E.; Pang, Lei; Williams-Diaz, Angela; Zerbe, Gary O.; Canniff, Jennifer; Johnson, Michael J.; Caldas, Yupanqui; Cho, Alice; Lang, Nancy; Su, Shu-Chih; Parrino, Janie; Popmihajlov, Zoran; Weinberg, Adriana

doi:10.1093/infdis/jiv480

Cited by 64 publications

(52 citation statements)

References 28 publications

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“…However, a booster dose has potential to reverse this decline in protection. A clinical trial found a booster dose of Zostavax, given ≥10 years after the first dose among adults ≥70 years, elicited a VZV antibody response similar to that of a first dose among age-matched subjects [113]. This booster dose was safe and some initial modeling work suggests such a vaccination strategy would be cost effective [101].…”

Section: Zoster Vaccine – Unresolved Questionsmentioning

confidence: 99%

Varicella and herpes zoster vaccine development: lessons learned

Warren‐Gash

Forbes

Breuer

2017

Expert Review of Vaccines

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Introduction: Before vaccination, varicella zoster virus (VZV), which is endemic worldwide, led to almost universal infection. This neurotropic virus persists lifelong by establishing latency in sensory ganglia, where its reactivation is controlled by VZV-specific T-cell immunity. Lifetime risk of VZV reactivation (zoster) is around 30%. Vaccine development was galvanised by the economic and societal burden of VZV, including debilitating zoster complications that largely affect older individuals. Areas covered: We describe the story of development, licensing and implementation of live attenuated vaccines against varicella and zoster. We consider the complex backdrop of VZV virology, pathogenesis and immune responses in the absence of suitable animal models and examine the changing epidemiology of VZV disease. We review the vaccines’ efficacy, safety, effectiveness and coverage using evidence from trials, observational studies from large routine health datasets and clinical post-marketing surveillance studies and outline newer developments in subunit and inactivated vaccines. Expert commentary: Safe and effective, varicella and zoster vaccines have already made major inroads into reducing the burden of VZV disease globally. As these live vaccines have the potential to reactivate and cause clinical disease, developing alternatives that do not establish latency is an attractive prospect but will require better understanding of latency mechanisms.

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Section: Zoster Vaccine – Unresolved Questionsmentioning

confidence: 99%

Varicella and herpes zoster vaccine development: lessons learned

Warren‐Gash

Forbes

Breuer

2017

Expert Review of Vaccines

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“…A recently published study reported fairly robust cellmediated immune responses after a booster dose in persons who had received an initial HZ vaccine 10 years earlier. 4 The potential clinical benefit of a booster should be weighed against its added cost.In this issue of the Journal of General Internal Medicine, Le and Rothberg report a methodologically robust and well-timed cost-effectiveness analysis which sought to determine the optimal schedule for the live attenuated HZ vaccine.5 This work builds upon their previously published and guidelinecited cost-effectiveness analysis of HZ vaccination. 1,6 The authors updated their well-developed Markov model, newly incorporated data regarding the long-term efficacy of the vaccine, and evaluated strategies entailing booster doses.…”

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confidence: 99%

“…Recent data have suggested that a booster might induce greater immunity than an initial dose in persons ≥70 years old. 4 We anxiously await reports of the clinical short-term and …”

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confidence: 99%

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confidence: 99%

“…1,6 The authors updated their well-developed Markov model, newly incorporated data regarding the long-term efficacy of the vaccine, and evaluated strategies entailing booster doses. 3,4 They examined 11 strategies, including no vaccination, onetime vaccination at various ages, a booster dose after 10 years, and two booster doses 10 years apart. They included a comprehensive list of key input parameters, including HZ incidence and its associated complications and quality-of-life decrements, age-and time-dependent vaccine efficacy, adherence to boosters, and vaccine costs.…”

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Herpes Zoster Vaccine: Time for a Boost?

Reddy

2016

J GEN INTERN MED

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O ne in three persons in the US will develop herpes zoster (HZ) during their lifetime, and the risk increases with age. 1 The disease is painful, often debilitating, and costly. Some cases result in postherpetic neuralgia (PHN), a chronic pain condition that can last months to years. In 2006, for the first time, a vaccine to prevent HZ and PHN became available in the US. A large-scale clinical trial in persons aged ≥60 years had shown that the live attenuated vaccine reduced HZ incidence by 51 % and PHN incidence by 67 % over a median 3.1-year follow-up period.2 Following this success, the Advisory Committee on Immunization Practices (ACIP) recommended one-time HZ vaccination for those ≥60 years of age.1 However, a follow-up study of the original trial cohort reported a substantial decline in HZ vaccine efficacy over time; by year 11 post-vaccination, there was essentially no protection. 3If HZ vaccination is successful, and yet protection is shortlived, a key challenge is finding the Bsweet spot^age at which to vaccinate. Such timing would protect people for the maximum length of time during which they are at highest risk of HZ and its complications. While the question of the optimal age at which to vaccinate remains, so does the related question of whether to administer a booster dose in the face of waning protection. Under the currently recommended strategy, those vaccinated only once at age 60 would be left unprotected after age 70, when the incidence and severity of HZ and PHN are highest. A recently published study reported fairly robust cellmediated immune responses after a booster dose in persons who had received an initial HZ vaccine 10 years earlier. 4 The potential clinical benefit of a booster should be weighed against its added cost.In this issue of the Journal of General Internal Medicine, Le and Rothberg report a methodologically robust and well-timed cost-effectiveness analysis which sought to determine the optimal schedule for the live attenuated HZ vaccine.5 This work builds upon their previously published and guidelinecited cost-effectiveness analysis of HZ vaccination. 1,6 The authors updated their well-developed Markov model, newly incorporated data regarding the long-term efficacy of the vaccine, and evaluated strategies entailing booster doses. 3,4 They examined 11 strategies, including no vaccination, onetime vaccination at various ages, a booster dose after 10 years, and two booster doses 10 years apart. They included a comprehensive list of key input parameters, including HZ incidence and its associated complications and quality-of-life decrements, age-and time-dependent vaccine efficacy, adherence to boosters, and vaccine costs. Model-generated results per strategy included HZ and PHN cases, per-person qualityadjusted life-years (QALYs), and per-person total costs. The authors reported incremental cost-effectiveness ratios (ICERs) and used a commonly cited, albeit somewhat arbitrary (and often considered too low), US threshold where interventions with an ICER <$100,000/QALY are conside...

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Evaluation of Varicella‐zoster virus‐specific cell‐mediated immunity by interferon‐γ Enzyme‐Linked Immunosorbent Assay in adults ≥50 years of age administered a herpes zoster vaccine

Yang

Chen

Zhang³

et al. 2019

Journal of Medical Virology

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Varicella‐zoster virus (VZV)‐specific cell‐mediated immunity (CMI) is critical for preventing and controlling the onset of herpes zoster (HZ). To assess VZV CMI, an interferon‐γ (IFN‐γ) enzyme‐linked immunosorbent assay (ELISA) was validated by examining the influence of VZV‐specific antigen content, incubation time, and interval from whole blood collection on the assay. In phase II clinical trial, VZV‐specific CMI in adults ≥50 years of age administered an HZ vaccine were evaluated by IFN‐γ ELISA, as determined by measuring IFN‐γ production in the whole blood in response to stimulation with ultraviolet light‐inactivated VZV. The VZV‐specific IFN‐γ levels varied among individuals from prevaccination (baseline) to 6 weeks postvaccination. In most subjects, VZV‐specific CMI was increased at 6 weeks postvaccination. The HZ vaccine elicited a significant increase in the VZV‐specific CMI response as measured by ELISA; the geometric mean fold‐rises from baseline to 6 weeks postvaccination were 3.50, 4.22, and 5.24 in the 4.3, 4.7, and 4.9 log plaque‐forming unit vaccine groups, respectively, which was significantly higher than in the placebo group (P < 0.05). These results indicate that vaccination enhances the VZV‐specific CMI responses in subjects; IFN‐γ ELISA is an effective method for evaluating the CMI response and may be useful for identifying individuals at a high risk of HZ infection.

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Cellular and Humoral Responses to a Second Dose of Herpes Zoster Vaccine Administered 10 Years After the First Dose Among Older Adults

Abstract: NCT01245751.

Cited by 64 publications

References 28 publications

Varicella and herpes zoster vaccine development: lessons learned

Varicella and herpes zoster vaccine development: lessons learned

Herpes Zoster Vaccine: Time for a Boost?

Evaluation of Varicella‐zoster virus‐specific cell‐mediated immunity by interferon‐γ Enzyme‐Linked Immunosorbent Assay in adults ≥50 years of age administered a herpes zoster vaccine

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