Systematic review of clinical studies suggests newer shingles vaccine far more effective

Dr. Andrea Tricco, a scientist with St. Michael's Hospital's Li Ka Shing Knowledge Institute and associate professor at the University of Toronto's Dalla Lana School of Public Health. Credit: St. Michael's Hospital

A systematic review of clinical studies involving more than two million patients aged 50 years and older suggests a recently released shingles vaccine was far more successful in preventing the painful condition compared to the older vaccine—but also carried greater risk of side-effects.
The research was published Thursday by The BMJ.

26 oct 2018--The adjuvant, recombinant subunit vaccine—sold under the brand name Shingrix—was found to be 85 per cent more effective in reducing cases of shingles, also known as herpes zoster, compared to Zostavax, which is a live-attenuated shingles vaccine available for use in Canada since 2006.
The use of Shingrix did lead to 30 per cent more injection-site adverse events, such as redness or swelling. No statistically significant differences were identified between the two vaccines for serious adverse events and deaths.
"There haven't been any head-to-head studies comparing the two shingles vaccines, so the results from our systematic review can be employed by policy-makers, clinicians, and patients to make their decisions on the use of these vaccines," said Dr. Andrea Tricco, a scientist with St. Michael's Hospital's Li Ka Shing Knowledge Institute and associate professor at the University of Toronto's Dalla Lana School of Public Health.
"If you have to choose between two vaccines and you have evidence showing that one of the vaccines is a little more effective, or a little safer than the other, then you might be more willing to take the safer and more effective one."
Shingles is a viral infection that occurs through reactivation of latent varicella zoster virus, which causes chickenpox.
About one in four people will develop shingles in their lifetime and about two-thirds get it after the age of 50.

More information: BMJ (2018). DOI: 10.1136/bmj.k4029 , http://bmj.com/cgi/content/full/bmj.k4029?ijkey=uacOnzgVx9acQsC&keytype=ref


Provided by St. Michael's Hospital

Experimental zoster vaccine effective in adults aged 70+

18 sept 2016—An experimental vaccine against herpes zoster may offer lasting protection for most older adults who receive it, according to a study published in the Sept. 15 issue of the New England Journal of Medicine.

The new trial involved 13,900 adults age 70 and older. Participants were randomly assigned to receive either two doses of the herpes zoster subunit vaccine (HZ/su) containing recombinant varicella-zoster virus glycoprotein E and the AS01_B adjuvant system, or two doses of a placebo.
The researchers found that the experimental vaccine protected 89.8 percent of adults age 70 and up. During a mean follow-up of 3.7 years, only 23 vaccine recipients developed herpes zoster, compared to 223 placebo recipients. There were short-lived side effects, such as pain at the injection site, fatigue, or muscle pain; however, serious adverse events occurred with similar frequencies in the two study groups.
"In our trial, HZ/su was found to reduce the risks of herpes zoster and postherpetic neuralgia among adults 70 years of age or older," the authors write.
The study was funded by GlaxoSmithKline, the developer of HZ/su.

More information: Abstract

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Editorial

Herpes zoster vaccine not cost-effective in adults aged 50 years

09 sept 2015—For adults aged 50 years, herpes zoster (HZ) vaccine does not appear to be cost-effective, according to a study published online Sept. 8 in the Annals of Internal Medicine.

Phuc Le, Ph.D., M.P.H., and Michael B. Rothberg, M.D., M.P.H., from the Cleveland Clinic, estimated the cost-effectiveness of HZ vaccine versus no vaccine in adults aged 50 years.
The researchers found that 25 HZ cases and one postherpetic neuralgia case could be prevented for every 1,000 persons receiving the vaccine at age 50 years. For HZ vaccine versus no vaccine, the incremental cost-effectiveness ratio (ICER) was $323,456 per quality-adjusted life-year (QALY). Vaccine cost (at a value of $80) and the rate at which efficacy wanes were the only variables that produced an ICER less than $100,000 per QALY in deterministic sensitivity analysis. The mean ICER was $500,754 per QALY in probabilistic sensitivity analysis. The probability that vaccination would be cost-effective was 3 percent at a willingness-to-pay threshold of $100,000 per QALY.
"Herpes zoster vaccine for persons aged 50 years does not seem to represent good value according to generally accepted standards," the authors write. "Our findings support the decision of the Advisory Committee on Immunization Practices not to recommend the vaccine for adults in this age group."

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Zoster vaccine associated with lower risk of shingles in older adults

Vaccination for herpes zoster, a painful rash commonly known as shingles, among a large group of older adults was associated with a reduced risk of this condition, regardless of age, race or the presence of chronic diseases, according to a study in the January 12 issue of JAMA.

12 jan 2011--"The pain of herpes zoster is often disabling and can last for months or even years, a complication termed postherpetic neuralgia. Approximately 1 million episodes of herpes zoster occur in the United States annually, but aside from age and immunosuppression, risk factors for this condition are not known," the authors write. Although prelicensure data provided evidence that herpes zoster vaccine works in a select study population under idealized circumstances, the vaccine needs to be evaluated in field conditions to show whether benefits of the vaccine can be generalized to conditions of clinical practice, according to background information in the article. The researchers note that this is particularly important for the herpes zoster vaccine, given the medical and physiological diversity in the elderly population for whom the vaccine is indicated.

Hung Fu Tseng, Ph.D., M.P.H., of Southern California Kaiser Permanente, Pasadena, Calif., and colleagues evaluated the risk of herpes zoster after receipt of herpes zoster vaccine among individuals in general practice settings. The study included community-dwelling adults, age 60 years or older, who were members of a managed care organization. There were 75,761 members in the vaccinated cohort, who were age matched (1:3) to 227,283 unvaccinated members.

Compared with the unvaccinated cohort, individuals in the vaccinated cohort were more likely to be white, women, and to have had more outpatient visits, and a lower prevalence of chronic diseases. There were 5,434 herpes zoster cases identified in the study (6.4 cases per 1,000 persons per year among vaccinated individuals and 13.0 cases per 1,000 persons per year among unvaccinated individuals). In the fully adjusted analysis, vaccination was associated with reduced risk of herpes zoster. The reduction in risk did not vary by age at vaccination, sex, race, or with presence of chronic diseases. Herpes zoster vaccine recipients had reduced risks of ophthalmic herpes zoster and hospitalizations coded as herpes zoster. Overall, the vaccine was associated with a 55 percent reduction in incidence of herpes zoster.

"Herpes zoster vaccine was licensed recently, which means the durability of its protection needs to be assessed in future studies. Meanwhile, however, this vaccine has the potential to annually prevent tens of thousands of cases of herpes zoster and postherpetic neuralgia nationally. To date, herpes zoster vaccine uptake has been poor due to weaknesses in the adult vaccine infrastructure and also due to serious barriers to the vaccine among clinicians and patients. Solutions to these challenges need to be found so that individuals seeking to receive herpes zoster vaccine will be able to reduce their risk of experiencing this serious condition," the authors conclude.

More information: JAMA. 2011;305[2]:160-166.

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