Herpes zoster vaccine effectiveness and manifestations of herpes zoster and associated pain by vaccination status

Abstract

Options for managing herpes zoster (HZ)-related pain and complications have limited effectiveness, making HZ prevention through vaccination an important strategy. Limited data are available on HZ vaccine effectiveness against confirmed HZ and manifestations of HZ among vaccinated persons. We conducted a matched case-control study to assess HZ vaccine effectiveness for prevention of HZ and other HZ-related outcomes and a cohort study of persons with HZ to compare HZ-related outcomes by vaccination status. Cases were identified through active surveillance among persons age 60 years with HZ onset and health-care encounters during 2010-2011 in Southeastern Minnesota. Controls were age-and sex-matched to cases. Data were collected by medical record review and from participants via interviews and daily pain diaries. 266 HZ case-patients and 362 matched controls were enrolled in the vaccine effectiveness studies and 303 case-patients in the cohort study of HZ characteristics by vaccination status. Vaccination was associated with 54% (95% CI:32%-69%) reduction in HZ incidence, 58% (95% CI:31%-75%) reduction in HZ prodromal symptoms, and 70% (95% CI:33%-87%) reduction in medically-attended prodrome. HZ vaccine was statistically significant effective at preventing postherpetic neuralgia (PHN) measured at 30 d after rash onset, 61% (95% CI: 22%-80%). Among persons who developed HZ, no differences were found by vaccination status in severity or duration of HZ pain after rash onset. In this population-based study, HZ vaccination was associated with >50% reduction in HZ, HZ prodrome, and medically-attended prodrome.

Prevention of herpes zoster and its complications: from the clinic to the real-life experience with the vaccine

“…Vaccination was associated with a 54 % reduction of HZ incidence (95 % CI, 32-69 %), a decrease of 58 % in prodromal symptoms (95 % CI, 31-75 %) and a 70 % reduction in prodromal medically assisted symptoms (95 % CI, 33-87 %). The vaccine was also effective against PHN, with definition at 30 days from the onset of the rash and a 61 % reduction (95 % CI, 22-80%) (Marin et al, 2015). In conclusion, these effectiveness studies are consistent with pre-marketing clinical studies, confirming a good safety and tolerability profile, as well as the efficacy against HZ and PHN in subjects 60 years.…”

“…Marin et al (2015) carried out a case-control study in subjects aged 60 years. Vaccination was associated with a 54 % reduction of HZ incidence (95 % CI, 32-69 %), a decrease of 58 % in prodromal symptoms (95 % CI, 31-75 %) and a 70 % reduction in prodromal medically assisted symptoms (95 % CI, 33-87 %).…”

T Lymphocytes as Measurable Targets of Protection and Vaccination Against Viral Disorders

“…The single dose, lyophilized, live, attenuated VZV vaccine (i.e., zoster vaccine live (Zvl), Zostavax, Merck) is indicated for prevention of latent VZV reactivation leading to shingles in individuals older than 50 years. ZVL is licensed in over 55 countries, with 34 million distributed doses globally (Willis et al, 2017), and which has associated efficacy rates of over 50% in all ages tested (Oxman et al, 2005;Schmader et al, 2012); consistent with original clinical trial datasets (Tseng et al, 2011;Langan et al, 2013;Marin et al, 2015). However, increases in VZV susceptibility have arisen due to increasing aging populations, and in immune-suppressed organ transplant recipients, chemotherapy patients, HIV-infected individuals, and those suffering from chronic illnesses (Forbes et al, 2014).…”

Insights into the role of immunosenescence during varicella zoster virus infection (shingles) in the aging cell model

“…In the elderly, increased susceptibility to herpes zoster and decreased vaccine efficacy are attributed to immunosenescence [7]. The roles and mechanisms of immunosenescence in the elderly during VZV infection are yet to be fully elucidated.…”