Potential public health impact of the adjuvanted recombinant zoster vaccine among people aged 50 years and older in Beijing

Abstract

Herpes zoster (HZ) is a painful, unilateral rash which occurs upon reactivation of latent varicella zoster virus due to age-related immunity decline or immuno-suppression. In 2019, the recombinant zoster vaccine (RZV) was the first vaccine to be approved in China for HZ prevention. This study aimed to estimate the potential public health impact of RZV vaccination, compared with the status quo of no vaccination, in individuals ≥50 years of age (YOA) in Beijing, by adapting the published ZOster ecoNomic Analysis (ZONA) model. We considered 5% and 50% vaccination coverage for the private market (nearterm post-launch) and mass vaccination (long-term) settings respectively. In the base-case analysis of both market settings, second-dose compliance was set to 80%. Coverage and second-dose compliance rates were varied under scenario and sensitivity analyses. In the base case, mass vaccination with RZV was estimated to prevent 435,681 HZ cases, 51,558 postherpetic neuralgia (PHN) cases, and 15,703 cases of other HZ-related complications in the overall ≥50 YOA cohort over their remaining lifetime, compared with no vaccination. Under the same base-case scenario, 14,247 hospitalizations and 1,031,387 outpatient visits could be avoided. The 50-59 YOA cohort had the highest contributions to the overall reduction in HZ cases, its complications and related healthcare resource utilization. Results were robust under numerous scenario and sensitivity analyses. This analysis demonstrates the potential of RZV vaccination to substantially reduce the public health burden of HZ among individuals ≥50 YOA, and may inform appropriate vaccination strategies for HZ prevention, particularly in urban settings within China.

How large could the public health impact of introducing recombinant zoster vaccination for people aged ≥50 years in five Latin American countries be?

“…As HZ is a relatively common affliction 1 and recurrence is possible, 44 the current model predicted that only 8–9 people aged 50–59 years up to 13–18 people aged ≥80 years would need to be vaccinated with RZV to prevent one case of HZ in the various countries studied due to the long-term protection afforded by this vaccine. These results are well aligned with results from Canada, 52 Germany, 21–23 the UK, 20 China, 26 , 53 and Japan. 27 …”

“…Our prediction that the youngest cohort would avoid the greatest number of HZ cases with vaccination is aligned with three studies from Germany 21–23 and one from China. 26 Our predictions that the percentages of HZ and PHN cases avoided would increase with age (HZ: 17.8% to 23.7%; PHN: 16.2% to 23.7%) aligns with data from US, which predicted that 21% to 41% of HZ cases and 8% to 41% of PHN cases would be prevented among people vaccinated at age 50 to 70 years, respectively. 17 …”

“…Obviously, the public health impact of RZV would increase as coverage rates increase over time. Although it is difficult to compare absolute case number reductions with those estimated in other studies due to the different population sizes, multiple studies from North America, 15–19 Europe, 20–25 and Asia 26–29 have also estimated that the introduction of routine RZV vaccination for older adults would proportionally reduce the burden of HZ.…”

“…12 Also, following a period of preference for RZV over ZVL, 13 the Advisory Committee on Immunization Practices in the US now only recommends a two-dose series of RZV for all adults aged ≥50 years, including those previously vaccinated with ZVL. 14 Multiple studies – in North America, 15–19 Europe, 20–25 and Asia 26–29 – have shown that the introduction of routine RZV vaccination for older adults could reduce the public health burden of HZ. Two recent meta-analyses have shown that routine RZV vaccination for older adults has the potential to be cost-effective 30 and consistently dominant over routine ZVL vaccination.…”

Herpes zoster: A Review of Clinical Manifestations and Management

“…The authors suggested that >14,000 hospitalizations and >1,000,000 outpatient visits could be avoided. Patients between 50 and 59 years had the greatest overall reduction in HZ cases, complications, and related healthcare resource use [101].…”