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  • Vaccine May Reduce Serious Shingles Complications in Seniors

    03/02/2017

    Immunization can significantly lower the risk of serious complications from shingles among older adults, suggest findings from a new study published in Clinical Infectious Diseases and available online. Drawing on data from approximately 2 million Medicare beneficiaries from 2007 to 2014, the retrospective cohort study evaluated the effectiveness and durability of the currently available, but under-utilized, vaccine. 

    Shingles, or herpes zoster, is a painful skin condition that occurs when the varicella-zoster virus, the same virus that causes chickenpox, is reactivated later in life in nerve cells. Almost one out of every three people in the United States will develop shingles during their lifetime. Because the incidence increases with age, seniors are particularly at risk. A live-attenuated vaccine, ZOSTAVAX®, was first licensed in the U.S. in 2006, after a clinical trial showed an overall 51 percent reduction in shingles incidence among patients aged 60 years or older.

    The new study results suggest that the vaccine is most effective against severe cases of shingles requiring hospitalization, as well as postherpetic neuralgia, a less common but serious complication of the virus which causes chronic pain. For preventing hospitalized cases of shingles, the virus showed 74 percent effectiveness in the first three years and 55 percent effectiveness after four or more years had passed since vaccination. Vaccine effectiveness against postherpetic neuralgia was 57 percent in the first three years after vaccination and 45 percent in the years that followed.

    “The fact that we found relatively high effectiveness against serious outcomes, such as hospitalization and postherpetic neuralgic, and that protection from these outcomes was sustained over time, adds to the considerable evidence that the vaccine is beneficial and that seniors should be encouraged to be vaccinated in higher numbers than what is happening currently,” said study author Hector S. Izurieta, MD, MPH, of the Food and Drug Administration’s Center for Biologics Evaluation and Research. The shingles vaccine is recommended in the U.S. for people 60 and older, but, in 2014, just 28 percent of adults in this demographic reported having received the vaccine, according to the Centers for Disease Control and Prevention.

    The study found little evidence to suggest that protection from shingles varied among different age groups within the study population, although the vaccine’s effectiveness declined over time. Protection against less serious cases of shingles not needing hospitalization was also considerably lower than protection against hospitalized cases and instances of postherpetic neuralgia.

    In an editorial commentary published with the study, Steven Black, MD, of Cincinnati Children’s Hospital, noted the efficacy of the authors’ approach, stressing the likelihood that the study’s results “most accurately reflect the impact of the vaccine in the Medicare population and, as almost all individuals over 65 years of age in the United States are enrolled in Medicare…the true effectiveness in seniors in the United States overall.”

    “Until other vaccine regimens and newer vaccines are evaluated,” Dr. Black wrote in his commentary, “it makes sense to continue with the current vaccination regimen to prevent a less than optimal but significant number of cases of the more serious complications.”

    Dr. Izurieta called the study’s findings reassuring but acknowledged the potential for more accurate and comprehensive studies in the future. “Better methods should be developed to control for bias in the analysis of observational studies, particularly when less severe outcomes, such as community herpes zoster, are considered,” he said. 

    Editor’s Note: This study was funded by the Food and Drug Administration. Additional funding was provided by the Office of the Assistant Secretary of Planning and Evaluation in the U.S Department of Health and Human Services. The study authors’ and commentary author’s affiliations, acknowledgments, and disclosures of financial support and potential conflicts of interests, if any, are available in the article and commentary.

    Effectiveness and Duration of Protection Provided by the Live-attenuated Herpes Zoster Vaccine in the Medicare Population Ages 65 Years and Older
    https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciw854

    Herpes Zoster Vaccine and the Medicare Population
    https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciw858

    ###

    Clinical Infectious Diseases is a leading journal in the field of infectious disease with a broad international readership. The journal publishes articles on a variety of subjects of interest to practitioners and researchers. Topics range from clinical descriptions of infections, public health, microbiology, and immunology to the prevention of infection, the evaluation of current and novel treatments, and the promotion of optimal practices for diagnosis and treatment. The journal publishes original research, editorial commentaries, review articles, and practice guidelines and is among the most highly cited journals in the field of infectious diseases. Clinical Infectious Diseases is an official publication of the Infectious Diseases Society of America (IDSA). Based in Arlington, Va., IDSA is a professional society representing nearly 10,000 physicians and scientists who specialize in infectious diseases. For more information, visit www.idsociety.org. Follow IDSA on Facebook and Twitter.

  •  Fast Facts

     

    • An FDA study of the currently available shingles vaccine showed higher rates of protection against serious outcomes of shingles, or herpes zoster, among seniors than against cases without complications and episodes that did not require hospitalization. 
    • In preventing hospitalized cases of shingles, the vaccine showed 74 percent effectiveness in the first three years and 55 percent effectiveness in the first four or more years after vaccination. 
    • In preventing postherpetic neuralgia, the vaccine showed 57 percent effectiveness in the first three years and 45 percent effectiveness four or more years after vaccination. 
    • The study authors found little evidence to suggest differences in vaccine effectiveness by age group, though protection against shingles declined over time.

     

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