Vaccination to Prevent Herpes Zoster and Postherpetic Neuralgia

Oxman, Michael N.

doi:10.4161/hv.3.2.3746

Cited by 18 publications

(12 citation statements)

References 27 publications

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“…As a matter of fact, while from the results of the "Zest Study", a double-blind clinical trial evaluating the efficacy and safety of the varicella-zoster vaccine in subjects 50-59-y-of-age, it emerged that the vaccine efficacy (VE) for the incidence of HZ in individuals aged 50-59 was 69.8%, 19 results from the "Shingles Prevention Study," a doubleblind clinical trial evaluating the vaccine efficacy in subjects 60-y-of-age or older, showed that the VE for the incidence of HZ in individuals ≥60 y was 51.3% (VE was 63.9% in subjects aged 60-69-y-old, but only 37,6% in subjects ≥70 y), and that the protection conferred against the most severe complications is higher in the older age groups. 20 In fact, the zoster vaccine reduces the incidence of postherpetic neuralgia by 66.5%, and VE for the incidence of PHN was higher, 66.8%, in subjects ≥70-y-ofage, precisely those most often affected by this complication (they accounted for 71% of the cases of PHN in the Shingles Prevention Study). Furthermore, it was observed that VE for the incidence of PHN increases to 73% when only cases with HZ Severity of Illness Scores > 600 (equivalent to > 60 d of the "worst pain imaginable") are taken into account, and to 82% when only cases with HZ Severity of Illness Scores > 800 (equivalent to >80 d of the "worst pain imaginable") are considered.…”

Section: Discussionmentioning

confidence: 98%

“…Furthermore, it was observed that VE for the incidence of PHN increases to 73% when only cases with HZ Severity of Illness Scores > 600 (equivalent to > 60 d of the "worst pain imaginable") are taken into account, and to 82% when only cases with HZ Severity of Illness Scores > 800 (equivalent to >80 d of the "worst pain imaginable") are considered. 20 Recently, in the systematic review by Kawai et al 21 on 15 costeffectiveness studies performed in the USA, Canada and Europe (Belgium, France, Germany, the Netherlands, Switzerland, and the UK), it was pointed out the likely cost-effectiveness of the HZ vaccine was pointed out. A cost ranging from 10.000$ to more than 100.000$ per QALY gained was calculated, the differences being mainly due to the differing assumptions on the duration of vaccine protection, on the loss in quality of life associated with HZ and PHN and on the risk of PHN in adults ≥70-y-of-age.…”

Section: Discussionmentioning

confidence: 99%

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The burden of disease of Herpes Zoster in Tuscany

Levi

Bellini

Capecchi

et al. 2014

Human Vaccines & Immunotherapeutics

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

The burden of disease of Herpes Zoster in Tuscany

Levi

Bellini

Capecchi

et al. 2014

Human Vaccines & Immunotherapeutics

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“…Migräne hat die höchste Prävalenz zwischen dem [30][31][32][33][34][35][36][37][38][39]. Lebensjahr (20,1%), danach nimmt die Prävalenz mit dem Alter stetig ab; um das 70.…”

Section: Migräneunclassified

“…Eine interessante neue Entwicklung ist die Auffrischimpfung für Varizella zoster für besonders gefährdete Patienten. Die Impfung führt zu einer relativen Risikoreduktion eines Herpes zoster von mehr als 50% und der postherpetischen Neuralgie von mehr als 65% [36]. …”

Section: Tab 3 Akutmedikation Von Kopfschmerzen Im Höheren Alter [23]unclassified

Kopfschmerzen im Alter

Reinisch

Schankin

Felbinger

et al. 2008

Schmerz

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Chronic headache is still a frequent problem in old age, affecting about 10% of all women and 5% of all men older than 70 years. The incidence of primary headache decreases with advancing age, while that of secondary headache increases. The clinical characteristics of migraine can also change with age; for example, vegetative symptoms are less prominent, and less intense migrainous pain localized predominantly in the neck is frequently reported. Migraine aura can also be experienced more frequently in isolation, without a headache. Hypnic headache is a rare primary headache syndrome that occurs almost exclusively in the elderly. Most of the secondary headache syndromes that occur more frequently in old age present clinically as tension-type headache. Examples of rather common reasons for secondary headache syndromes in the elderly are intracranial space-occupying lesions, ophthalmological problems and autoimmune diseases such as giant cell arteritis. Elderly patients are especially likely to have a number of illnesses at any one time for which they take various medications each day, so that headaches can also quite often be caused by their medication or by withdrawal of these. As a result of such multimorbidity the homeostasis is disturbed in such patients, leading to various conditions that can entail concomitant headaches (sleep apnoea syndrome, dialysis headache, headache attributed to arterial hypertension or hypothyroidism). Familiar facial neuralgias, such as trigeminal neuralgia or postherpetic neuralgia following manifest herpes zoster affecting the face, become markedly more frequent with age. In general, in the treatment of headaches in the elderly it is essential to pay careful attention to potential interactions with the multiple drugs needed because of other diseases; in addition, the comorbidities themselves have to be taken into account, especially depression, anxiety and cognitive impairment, necessitating multimodal, interdisciplinary therapy plans.

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“…This higher viral potency is required to yield a satisfactory boost in the immune response in older adults. 36 (See also…”

Section: 28mentioning

confidence: 99%

Adverse events following vaccination of older people may be under‐reported

Clothier

Crawford

Russell

et al. 2017

Medical Journal of Australia

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 Herpes zoster or 'shingles' is a localised, painful, vesicular skin rash resulting from reactivation of the same virus (the varicella-zoster virus) that causes chickenpox earlier in life. Shingles can affect any part of the body but the rash classically takes the shape of a belt or band in the thoracic or lumbar region. Although usually self-limiting, shingles can lead to post-herpetic neuralgia (PHN), a chronic neuropathic pain syndrome, and other complications. About 20-30% of people will have shingles in their lifetime, most after the age of 50 years. Older people (particularly those aged over 70 years) are also more likely to have shingles complicated by PHN. Who should be vaccinated There is one zoster vaccine that is registered for use in people aged 50 years and over as a single dose. It is recommended for adults aged 60 years and over who are not immunocompromised. Zoster vaccine is funded under the National Immunisation Program for persons aged 70 years, with catch-up for those aged 71-79 years also funded until October 2021. Who should not be vaccinated People who are immunocompromised due to disease or medication, pregnant women, and those who have previously had anaphylaxis to any VZV-containing vaccine or its components should not receive the zoster vaccine. Vaccine The vaccine contains live attenuated varicella-zoster virus. The amount of virus in the zoster vaccine is approximately 14 times greater than in varicella (chickenpox) vaccines. Vaccination of people aged 70-79 years is estimated to prevent about 41% of the cases of shingles and two-thirds of post-herpetic neuralgia cases in that population. In vaccinated people in whom an episode of shingles occurs, the pain, severity and duration is reduced by 50%. Protection from vaccination tends to decline with older age at vaccination and the time since vaccination. However, a booster dose is not currently recommended. Medical therapy (such as analgesics and antivirals) should still be considered for treatment of shingles, regardless of the patient's immunisation status. The vaccine is safe and well tolerated among immunocompetent individuals aged 50 years and over in clinical trials and post-licensure studies. Mild reactions at the injection site, such as pain, swelling and redness, are likely to occur in approximately 50% of vaccine recipients.

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Vaccination to Prevent Herpes Zoster and Postherpetic Neuralgia

Cited by 18 publications

References 27 publications

The burden of disease of Herpes Zoster in Tuscany

The burden of disease of Herpes Zoster in Tuscany

Kopfschmerzen im Alter

Adverse events following vaccination of older people may be under‐reported

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