Herpes zoster vaccine: a shot to maintain wellbeing

Abstract

The current era is full of contradictory vaccine issues. The emerging Ebola pandemic stimulates the world's citizens who are calling for the urgent development of vaccine to prevent the disease [1]. They seem to be suddenly remembering that vaccines represent a major advancement in public health [2]. While the complete eradication of polio, neonatal tetanus, congenital rubella, and measles are still the main targets in less developed countries [3], inhabitants of high-resource countries are focusing on rare adverse effects of vaccines to discredit the efficacy and effectiveness of vaccination. As a result, there is an increase in vaccine-preventable diseases in both children and adults. Indeed, it has been estimated that ten times more adults (40 to 50 thousand) die than children in the USA annually from potentially vaccine-preventable diseases [4].In this controversial context, alongside vaccines for lifethreatening diseases, there have emerged new vaccines to prevent the occurrence of diseases and their complications. Herpes zoster (HZ) vaccine [5][6][7], is the best example of such quality improvement vaccines. In this issue, Stefania Maggi and collaborators present a comprehensive and upto-date review of how the HZ vaccine improves healthy ageing [8]. This paper raises some questions concerning the global epidemiology of the disease, improved knowledge of HZ risk factors, the well-known and more surprising consequences of the disease, as well as the increasing dilemma about age and the new indications for the currently available vaccine.The incidence rate (IR) of HZ in Italy, at 6.3 per thousand person-years [8,9], is higher than the mean incidence rate of 3-5 per thousand person-years reported in an analysis of 130 studies conducted in 26 countries in North America, Europe, and Asia-Pacific [10]. This could be related to a temporal increase in the incidence of HZ, often occurring before the introduction of varicella vaccination programmes [11], as in Finland [11] and Germany [12]. In the United Kingdom, one study reported that the median age at HZ diagnosis was 62 years (interquartile range 48-73) [13]. The IR was more or less stable between the ages of 10 and 44 years (at around 2.4 per thousand personyears), but increased more than threefold, to reach 15 in the 80-84 year old age group [12]. In the same study population, the IR was 36 % higher in females than in males [12]. Prodromic pain was experienced by 69.5 % of South Korean patients, of whom 95.1 % had moderate-to-severe pain [14]. In Italy, postherpetic neuralgia (PHN) occurred in 20.6 and 9.2 % of HZ patients older than 50 years after 3 and 6 months respectively [8,15], which corresponds to the mean 6-month PHN risk reported in the world literature [16].The risk factors for HZ have recently been better identified, and Maggi's paper describes them in detail [8]. However, it is important to insist on a few of these factors. In a study cohort of 144,959 adults diagnosed with herpes zoster between 2000 and 2011, severely immunosuppressive conditions r...

Regulation of Cardiac Autonomic Nervous System Control across Frailty Statuses: A Systematic Review

“…Inclusion/exclusion criteria as outlined above were applied to the full text of 54 articles and 48 articles were excluded due to the following reasons: 1) lack of a standard definition of frailty (n=31); 2) lack of HR or HRV measurements (n=8); 3) were conference abstract (n=5); 4) were non-English articles (n=3); and 5) was a systematic review (n=1). Finally, six articles [12, 13, 24–27] met all inclusion criteria (Figure 1). …”

“…Interestingly, none of the included studies performed power calculation. Katayama et al was the only study that reported response rate [24]. Four research studies lack a sufficient report of parameters [12, 13, 24, 27]; statistical value (e.g., mean and standard deviation) for extracted parameters was not reported for these four articles [12, 13, 24, 27], and in three articles demographic information was not reported individually for each frailty group [12, 13, 27].…”

“…Total of 919 non-frail and 305 frail were studied among selected articles (excluding Weiss et al study [27], within which the number of frail and non-frail participants was not provided). Interestingly, in four out of the six studies only female participants were recruited [12, 13, 24, 27]. Three of these studies [12, 13, 27] retrospectively analyzed different data subsets from Women’s Health and Aging Study (WHAS) which was originally designed for investigation of the epidemiology of disability progression in non-institutionalized women aged 65 and older [28].…”

“…Three of these studies [12, 13, 27] retrospectively analyzed different data subsets from Women’s Health and Aging Study (WHAS) which was originally designed for investigation of the epidemiology of disability progression in non-institutionalized women aged 65 and older [28]. Katayama et al [24] did not explain the reason for recruiting only women.…”

“…In three studies [12, 13, 27] participants were categorized into non-frail and frail, and in two studies [24, 26] into non-frail, pre-frail, and frail according to Fried’s criteria. In one study [25] participants were categorized into three categories: non-frail, pre-frail and frail, using a modified version of the Fried’s criteria.…”