Efficacy, effectiveness, and safety of herpes zoster vaccine in the immunocompetent and immunocompromised subjects: A systematic review and network meta-analysis

Abstract

ObjectiveTo investigate the efficacy, effectiveness and safety of recombinant zoster vaccine (RZV) and zoster vaccine live (ZVL) in immunocompetent and immunocompromised subjects.MethodsData sources: PubMed, EMBASE, Cochrane Library, and Web of Science databases (up to Jan 2022) were searched to identify English articles. Search terms included randomized controlled trials (RCTs), observational studies, herpes zoster, RZV, ZVL. Study Selection: Only randomized controlled trials (RCTs) evaluating vaccine efficacy and safety and observational studies assessing vaccine effectiveness (after a vaccine was approved for marketing) were included. Data Extraction: Two researchers independently screened the literature, extracted the data, and checked the each other results.ResultsSeventeen RCTs and 19 cohort studies were included. Among immunocompetent subjects, RZV was superior to ZVL at wide intervals (relative vaccine efficacy: 84%, 95% CI: 53%–95%; relative vaccine effectiveness: 49%, 95% CI: 21%–67%), across genders and subjects aged ≥ 60 years. Among immunocompromised subjects, RZV was superior to placebo in terms of vaccine efficacy (60%, 95% CI: 49%–69%). There was no difference between ZVL and placebo in those with selected immunosuppressive conditions. RZV was 45% (95% CI: 30%–59%) superior to ZVL in real-world practice. Compared with placebo, adverse events related to RZV were primarily related to injection-site and systemic, and RZV did not increase the risk of serious adverse events (SAEs) or death. There was no difference in the incidence of adverse events between groups with and without immunosuppression.ConclusionsBoth RZV and ZVL can reduce the risk of herpes zoster in both immunocompetent and immunocompromised subjects. RZV was well-tolerated in the study population and demonstrated stronger protection than ZVL.Systematic review registrationProspero CRD42022310495.

Public health impact of herpes zoster vaccination on older adults in Hong Kong

“…NNV is frequently used to compare potential benefits of different vaccination strategies in literature, 53 and the lower NNV for RZV compared with ZVL is due to the higher initial vaccine efficacy and sustained protection conferred by RZV over the projected period. Furthermore, our findings are supported by Xia et al, 54 a recent systematic review and network meta-analysis of global data, which reported that RZV was statistically superior to no vaccination and ZVL in terms of vaccine effectiveness. In particular, Xia et al 54 also found that RZV provided 36% and 45% more protection than ZVL in RCTs and medical practice, respectively.…”

“…Furthermore, our findings are supported by Xia et al, 54 a recent systematic review and network meta-analysis of global data, which reported that RZV was statistically superior to no vaccination and ZVL in terms of vaccine effectiveness. In particular, Xia et al 54 also found that RZV provided 36% and 45% more protection than ZVL in RCTs and medical practice, respectively.…”

Public health impact of herpes zoster vaccination on older adults in Singapore: a modeling study

“…For vaccine-related parameters, model inputs of vaccine efficacy were based on data sources, 33 , 34 , 67 which align with the studies identified in a recent systematic review and meta-analysis assessing HZ vaccine efficacy in immunocompetent individuals. 84 …”

Updated Considerations for the Immunopharmacological Aspects of the “Talented mRNA Vaccines”

“…Varicella zoster virus is a serious health threat due to the importance of its consequences, especially considering post-herpetic neuropathy. It is currently targeted by a live attenuated vaccine and by a recombinant vaccine; their efficacy is reported to be 84% at best, with two administrations of the recombinant one in immunocompetent subjects, but it can be absent in immunocompromised individuals using the live attenuated one [ 148 ]. Moreover, the vaccine effectiveness in preventing infection symptoms is reported to be generally lower [ 149 ] and the prevention of post-herpetic neuralgia remains an unmet medical need.…”