Vaccination against Herpes Zoster and Postherpetic Neuralgia

Abstract

Background. Herpes zoster (HZ) and postherpetic neuralgia (PHN) cause significant morbidity in older adults. The incidence and severity of HZ and PHN increase with age in association with an age-related decline in varicellazoster virus (VZV)-specific cell-mediated immunity (VZV-CMI). VZV vaccines can boost VZV-CMI. Therefore, we tested the hypothesis that VZV vaccination would protect older adults against HZ and PHN.Methods. We enrolled 38,546 adults у60 years of age in a randomized, double-blind, placebo-controlled trial of an investigational HZ vaccine and actively followed subjects for the development of HZ. The primary end point was the burden of illness due to HZ (HZ BOI), a composite measure of the incidence, severity, and duration of pain and discomfort caused by HZ. The secondary end point was the incidence of PHN.Results. Subject retention was 195%. HZ vaccine reduced the HZ BOI by 61.1% (95% confidence interval [CI], 51.1%-69.1%;) and reduced the incidence of PHN by 66.5% (95% CI, 47.5%-79.2%; ). The P ! .001 P ! .001 incidence of HZ was also reduced by 51.3% (95% CI, 44.2%-57.6%;). HZ vaccine was well tolerated; P ! .001 injection site reactions were generally mild. HZ vaccine neither caused nor induced HZ.Conclusion. The Shingles Prevention Study demonstrated that HZ vaccine significantly reduced the morbidity due to HZ and PHN in older adults.

Varicella Zoster Virus: A Common Cause of Stroke in Children and Adults

“…Post-licensure studies have confirmed the vaccine's safety and efficacy (50,51). Unfortunately, participation in the zoster vaccine program has been low, likely due to cost and failure to recognize the importance of preventing infectious diseases in older adults.…”

Varicella zoster virus infection

“…The duration of pain and discomfort among subjects with zoster was shorter in vaccinated candidates compared with placebo recipients 22,152 . The vaccine reduced the incidence of zoster by 51.3% (63.9% in people aged 60-69 years but only 37.6% in people aged ≥70 years).…”

“…In the Shingles Prevention Study (SPS), a doubleblind, placebo-controlled trial, 38,546 healthy adults aged ≥60 years (median 69 years) were randomly assigned to receive a single dose of high-potency vOka (14 times greater potency than the varicella vaccine) or placebo 22,151,152 . Two co-primary end points were investigated: the burden of illness owing to zoster (a severity-by-duration measure representing the total pain and discomfort) and the incidence of clinically significant PHN.…”

“…A total of 19,270 people who received the zoster vaccine and 19,276 who received placebo were followed up on average for 3.13 years 22,152 . There were 957 confirmed evaluable cases of zoster (315 in vaccine recipients and 642 in placebo recipients).…”

“…The incidence of clinically significant PHN was reduced by more than 65% for both age groups. Furthermore, the zoster vaccine reduced the percentage of people with zoster who developed PHN by >31%, with most benefit in the group aged ≥70 years, which had the highest risk of developing this complication 22,152 . The SPS also demonstrated that the vaccine reduced the adverse impact of zoster on patients' capacity to perform activities of daily living and health-related quality of life 153 .…”