Prevention strategies: herpes zoster, post-herpetic neuralgia and immunogenicity.

Herpes zoster is a common condition that can have a significant impact on quality of life among older adults. A significant proportion of older subjects with herpes zoster develop post-herpetic neuralgia (PHN), a chronic condition that is difficult to treat. The Shingles Prevention Study was a large-scale clinical trial to determine the efficacy of a live, attenuated varicella zoster virus (VZV) vaccine ('zoster vaccine') for preventing or attenuating herpes zoster in subjects aged > or =60 years. A total of 38 546 subjects were given either zoster vaccine or placebo. The burden of illness (pain severity-by-duration), incidence of herpes zoster, and PHN decreased by 61.1%, 51.3% and 66.5% (all P<0.001), respectively, following vaccination. Vaccine efficacy was maintained for a 4-year follow-up period. A sub-study of the vaccine trial evaluated VZV-specific immunity in approximately 1200 vaccine or placebo recipients prior to vaccination, at 3 months and annually for 3 years. VZV-specific cell-mediated immunity (CMI) was boosted significantly by the zoster vaccine. This boost remained substantially intact for the 3 years of follow-up. It is likely that the vaccine-induced boost in VZV-specific CMI reversed the natural decline in these responses that occurs as part of the ageing process, thereby protecting vaccine recipients against herpes zoster and its complications.

Duke Scholars

Author Kenneth Edwin Schmader Medicine, Geriatrics