Systematic Review and Meta-analysis of Herpes Zoster Vaccine in Patients With CKD

Hamad, Mohamad A.; Allam, Hilda; Sulaiman, Ashna; Murali, Karumathil; Hassan, Hicham I. Cheikh

doi:10.1016/j.ekir.2021.02.024

Cited by 9 publications

(5 citation statements)

References 56 publications

(139 reference statements)

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“…A significantly reduced risk of stroke (relative incidence = 0.58; 95% CI: 0.44–0.78) following the zoster vaccine live immunisation has been reported in a recent self-controlled case series study 16 . The main difference between our findings and numerous antecedent studies is that measure of association for the pre-specified adverse events was closer to one, or the confidence interval of the measure crossed one 5 , 6 , 8 , 13 , 16 , 22 . The apparent protective effect observed in our study could be attributed to the zoster vaccine’s live effectiveness against herpes zoster and associated complications, the healthy vaccine effect, delayed serious adverse events following vaccination, and healthy vaccine bias and healthy vaccinee time 14 , 16 .…”

Section: Discussioncontrasting

confidence: 91%

Herpes zoster vaccine safety in the Aotearoa New Zealand population: a self-controlled case series study

et al. 2023

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In Aotearoa New Zealand, zoster vaccine live is used for the prevention of zoster and associated complications in adults. This study assessed the risk of pre-specified serious adverse events following zoster vaccine live immunisation among adults in routine clinical practice. We conducted a self-controlled case series study using routinely collected national data. We compared the incidence of serious adverse events during the at-risk period with the control period. Rate ratios were estimated using Conditional Poisson regression models. Falsification outcomes analyses were used to evaluate biases in our study population. From April 2018 to July 2021, 278,375 received the vaccine. The rate ratio of serious adverse events following immunisation was 0·43 (95% confidence interval [CI]: 0·37–0·50). There was no significant increase in the risk of cerebrovascular accidents, acute myocardial infarction, acute pericarditis, acute myocarditis, and Ramsay–Hunt Syndrome. The herpes zoster vaccine is safe in adults in Aotearoa New Zealand.

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Section: Discussioncontrasting

confidence: 91%

Herpes zoster vaccine safety in the Aotearoa New Zealand population: a self-controlled case series study

et al. 2023

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“…A 2021 meta-analysis by Hamed and colleagues, involving eight studies and 404,561 adults, found that the zoster vaccine live significantly reduced the risk of herpes zoster in patients with chronic kidney diseases (hazard ratio = 0.55, 95% CI 0.37-0.82). The heterogeneity (I² = 88%, p<0.01) was higher than that reported in our study (I² = 0%, p=0.93) (Hamad et al, 2021).…”

Section: Prisma Flow Diagramcontrasting

confidence: 85%

“…A significantly reduced risk of stroke (relative incidence = 0.58; 95% CI: 0.44-0.78) following the zoster vaccine live immunisation has been reported in a recent self-controlled case series study (Totterdell et al, 2020). The main difference between our findings and numerous antecedent studies is that measure of association for the pre-specified adverse events was closer to one, or the confidence interval of the measure crossed one (Gagliardi et al, 2019;Hamad et al, 2021;Totterdell et al, 2020;Tseng et al, 2012b). The apparent protective effect observed in our study could be attributed to the zoster vaccine's live effectiveness against herpes zoster and associated complications, the healthy vaccine effect, delayed serious adverse events following vaccination, and healthy vaccine bias and healthy vaccinee time (Baxter et al, 2012;Totterdell et al, 2020).…”

Section: Discussionsupporting

confidence: 42%

An Evaluation of the Epidemiology, Vaccine Effectiveness and Vaccine Safety of Herpes Zoster Vaccination

Mbinta¹

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Background Herpes zoster is characterised by a painful vesicular rash and, in older people, often leads to post-herpetic neuralgia and prolonged pain with a subsequent negative impact on quality of life and functional status. Herpes zoster vaccines have been demonstrated to be effective and safe. The objective was to evaluate the epidemiology of herpes zoster, vaccine effectiveness and vaccine safety of herpes zoster vaccination. Methods A systematic review and meta-analysis were carried out to evaluate the international evidence on the effectiveness of zoster vaccines. National retrospective observational cross-sectional (2006–2018), retrospective matched cohort (2018–2021), and self-controlled case series (2018–2021) studies were carried out using routinely collected data from the Ministry of Health, New Zealand. Adjusted ratios were determined using appropriate regression models. Adjusted ratios were used to estimate vaccine effectiveness, and vaccine safety was evaluated using pre-specified serious adverse events. Results Thirteen articles were included in the meta-analysis. The overall quality of evidence was very low for all outcomes. The pooled vaccine effectiveness for zoster vaccine live against herpes zoster in adults was 45.9% (95% confidence interval [CI]:42.2–49.4), and against postherpetic neuralgia, was 59.7% (95% CI: 58.4–89.7). The pooled vaccine effectiveness for recombinant zoster vaccine against herpes zoster in adults was 79.2% (95% CI: 57.6–89.7). A total of 10,865 herpes zoster hospitalisations, 203,021 community herpes zoster, and 2,304 postherpetic neuralgia hospitalisations were identified between 2006 and 2018. The incidence of herpes zoster was 3.68 (95% CI: 3.67–3.70) per 1,000 population, and the incidence of hospitalised postherpetic neuralgia was 0.04 (95% CI: 0.038–0.041) per 1,000 population. A total of 824,142 (274,272 vaccinated with the zoster vaccine live matched with 549,870 unvaccinated) adults were included in the study. The vaccine effectiveness against hospitalised herpes zoster and postherpetic neuralgia was 57.8% (95% CI: 41.1–69.8) and 73.7% (95% CI:14.0–92.0), respectively. The vaccine effectiveness against community herpes zoster was 30.0% (95% CI: 25.6–34.5). During the follow-up period, 1082 (0.4%) vaccinated people were hospitalised for the pre-specified adverse event during the at-risk and control windows and included in the study population. Overall, the rate ratio of serious adverse events following immunisation was 0.43 (95% CI: 0.37–0.50). There was no significant increase in the risk of cerebrovascular accidents (rate ratio = 0.46; 95% CI: 0.36–0.56), acute myocardial infarction (rate ratio = 0.28; 0.16–0.47), acute pericarditis (rate ratio = 0.44; 95% CI: 0.12–1.33), acute myocarditis (rate ratio = 0.21; 95% CI: 0.01–2.12) and Ramsay–Hunt Syndrome (rate ratio = 0.79; 95% CI: 0.11–5.68) in the at-risk period compared to the control period (background level). Conclusion Herpes zoster and postherpetic neuralgia affect all population groups, and the incidence increases with age. Herpes zoster vaccines are safe and effective in preventing herpes zoster and associated complications in routine clinical practice.

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“…A total of 32 systematic reviews focused on non-COVID-19 vaccines ( Table 3 ). Several vaccines were studied, including inactivated hepatitis A vaccine [ 32 ], recombinant hepatitis B vaccine [ 33 , 34 , 35 , 36 , 37 , 38 ], recombinant human papillomavirus vaccines [ 39 , 40 ], inactivated influenza vaccine [ 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ], live-attenuated measles vaccine (given post hematopoietic stem-cell transplantation [ 52 ] and in children living with human immunodeficiency virus [ 53 ]), pneumococcal conjugate and polysaccharide vaccines [ 46 , 49 , 54 , 55 , 56 ], live-attenuated and recombinant subunit zoster vaccines [ 57 , 58 ], live-attenuated yellow fever vaccine [ 59 ], and others [ 60 , 61 , 62 , 63 ]. Immunocompromised states studied included use of B-cell-depleting anti-CD20 therapy, chronic kidney failure, human immunodeficiency virus infection, immune-mediated inflammatory diseases, liver cirrhosis, malignancy, post-splenectomy status, and solid organ transplant recipients.…”

Section: Resultsmentioning

confidence: 99%

Vaccination for the Prevention of Infection among Immunocompromised Patients: A Concise Review of Recent Systematic Reviews

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2022

Vaccines

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Vaccination is crucial for avoiding infection-associated morbidity and mortality among immunocompromised patients. However, immunocompromised patients respond less well to vaccinations compared to healthy people, and little is known about the relative efficacy of various vaccines among different immunocompromised states. A total of 54 systematic reviews (22 COVID-19; 32 non-COVID-19) published within the last 5 years in Pubmed® were reviewed. They demonstrated similar patterns within three seroconversion response categories: good (about >60% when compared to healthy controls), intermediate (~40–60%), and poor (about <40%). Good vaccine responses would be expected for patients with chronic kidney disease, human immunodeficiency virus infection (normal CD4 counts), immune-mediated inflammatory diseases, post-splenectomy states, and solid tumors. Intermediate vaccine responses would be expected for patients with anti-cytotoxic T-lymphocyte antigen-4 therapy, hematologic cancer, and human immunodeficiency virus infection (low CD4 counts). Poor vaccine responses would be expected for patients with B-cell-depleting agents (e.g., anti-CD20 therapy), hematopoietic stem-cell transplant, solid organ transplant, and liver cirrhosis. For all vaccine response categories, vaccination should be timed when patients are least immunosuppressed. For the intermediate and poor vaccine response categories, high-dose vaccine, revaccination when patients are less immunosuppressed, checking for seroconversion, additional booster doses, and long-acting monoclonal antibodies may be considered, supplemented by shielding measures.

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Systematic Review and Meta-analysis of Herpes Zoster Vaccine in Patients With CKD

Cited by 9 publications

References 56 publications

Herpes zoster vaccine safety in the Aotearoa New Zealand population: a self-controlled case series study

Herpes zoster vaccine safety in the Aotearoa New Zealand population: a self-controlled case series study

An Evaluation of the Epidemiology, Vaccine Effectiveness and Vaccine Safety of Herpes Zoster Vaccination

Vaccination for the Prevention of Infection among Immunocompromised Patients: A Concise Review of Recent Systematic Reviews

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