Skip to main content

Advertisement

Log in

The Importance of Vaccination Against Herpes Zoster

  • Ocular Microbiology and Immunology (B Jeng and L Schocket, Section Editors)
  • Published:
Current Ophthalmology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

In this review, we will discuss herpes zoster, a common, serious, and potentially vision and life-threatening preventable disease. We will also review the two available zoster vaccines and discuss the current Food and Drug Administration (FDA) approvals and Center for Disease Control (CDC) recommendations regarding herpes zoster vaccination.

Recent Findings

The incidence of herpes zoster is increasing, the age of onset is decreasing, and more complications are being reported. The zoster vaccine live (ZVL), which contains a live attenuated virus, has been CDC recommended for immunocompetent adults age 60 years and older since 2008, and FDA approved for immunocompetent adults age 50 years and older since 2011. Under-usage of this vaccine remains a problem. The recombinant zoster vaccine (RZV), which contains a viral antigen in a novel adjuvant, was approved by the FDA in October 2017 for adults age 50 years and older. In January 2018, the CDC recommended this vaccine as preferred for immunocompetent adults age 50 years and older, including those who have received the zoster vaccine live in the past.

Summary

Now that there are two approved and recommended vaccines against zoster, including a new one requiring a two-shot series that appears more effective, it should be a high priority for physicians, including primary care doctors, ophthalmologists, and dermatologists, as well as other health care professionals, to increase vaccination rates of adults age 50 years and older against zoster and prevent this painful and potentially devastating disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Suaya JA, Chen S-Y, Li Q, Burstin SJ, Levin MJ. Incidence of herpes zoster and persistent post-zoster pain in adults with or without diabetes in the United States. Open Forum Infect Dis. 2014;1:ofu049–9.

  2. Wareham DW, Breuer J. Herpes zoster. BMJ. 2007;334:1211–5.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lee HL, Yeo M, Choi GH, Lee JY, Kim JS, Shin D-I, et al. Clinical characteristics of headache or facial pain prior to the development of acute herpes zoster of the head. Clin Neurol Neurosurg. 2017;152:90–4.

  4. Kawai K, Gebremeskel BG, Acosta CJ. Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open. 2014;4:e004833.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kawai K, Yawn BP. Risk factors for herpes zoster: a systematic review and meta-analysis. Mayo Clin Proc. 2017;92:1806–21.

    Article  PubMed  Google Scholar 

  6. Leung J, Harpaz R, Molinari N-A, Jumaan A, Zhou F. Herpes zoster incidence among insured persons in the United States, 1993–2006: evaluation of impact of varicella vaccination. Clin Infect Dis. 2011;52:332–40.

    Article  PubMed  Google Scholar 

  7. Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc. 2007;82:1341–9.

    Article  PubMed  Google Scholar 

  8. Russell ML, Dover DC, Simmonds KA, Svenson LW. Shingles in Alberta: before and after publicly funded varicella vaccination. Vaccine. 2014;32:6319–24.

    Article  PubMed  Google Scholar 

  9. • Kawai K, Yawn BP, Wollan P, Harpaz R. Increasing incidence of herpes zoster over a 60-year period from a population-based study. Clin Infect Dis. 2016;63:221–6. Population-based cohort study demonstrating that the incidence of herpes zoster has increased greater than fourfold over the past 60 years.–6.

  10. Insinga RP, Itzler RF, Pellissier JM, Saddier P, Nikas AA. The incidence of herpes zoster in a United States administrative database. J Gen Intern Med. 2005;20:748–53.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hernandez PO, Javed S, Mendoza N, Lapolla W, Hicks LD, Tyring SK. Family history and herpes zoster risk in the era of shingles vaccination. J Clin Virol. 2011;52:344–8.

    Article  PubMed  Google Scholar 

  12. Chan AY, Conrady CD, Ding K, Dvorak JD, Stone DU. Factors associated with age of onset of herpes zoster ophthalmicus. Cornea. 2015;34:535–40.

    Article  PubMed  Google Scholar 

  13. Davies EC, Pavan-Langston D, Chodosh J. Herpes zoster ophthalmicus: declining age at presentation. Br J Ophthalmol. 2016;100:312–4.

    Article  PubMed  Google Scholar 

  14. Tung Y-C, Tu H-P, Tsai W-C, Chen C-S, Su C-H, Shi H-Y, et al. Increased incidence of herpes zoster and postherpetic neuralgia in adult patients following traumatic brain injury: a nationwide population-based study in Taiwan. PLoS One. 2015;10:e0129043.

  15. Wu P-H, Lin Y-T, Lin C-Y, Huang M-Y, Chang W-C, Chang W-P. A nationwide population-based cohort study to identify the correlation between heart failure and the subsequent risk of herpes zoster. BMC Infect Dis. 2015;15:17.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Peng Y-H, Fang H-Y, Wu B-R, Kao C-H, Chen H-J, Hsia T-C, et al. Adult asthma is associated with an increased risk of herpes zoster: a population-based cohort study. J Asthma. 2017;54:250–7.

    Article  PubMed  Google Scholar 

  17. Yang W-S, Hu F-C, Chen M-K, Ko W-J, Chen L, Wu K-D, et al. High risk of herpes zoster among patients with advance acute kidney injury—a population-based study. Sci Rep. 2015;5:13747.

  18. Yawn BP, Wollan PC, Kurland MJ, St Sauver JL, Saddier P. Herpes zoster recurrences more frequent than previously reported. Mayo Clin Proc. 2011;86:88–93.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Zhang Y, Luo G, Huang Y, Yu Q, Wang L, Li K. Risk of stroke/transient ischemic attack or myocardial infarction with herpes zoster: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis. 2017;26:1807–16.

    Article  PubMed  Google Scholar 

  20. Liu X, Guan Y, Hou L, Huang H, Liu H, Li C, et al. The short- and long-term risk of stroke after herpes zoster: a meta-analysis. PLoS One. 2016;11:e0165203.

  21. Breuer J, Pacou M, Gautier A, Brown MM. Herpes zoster as a risk factor for stroke and TIA: a retrospective cohort study in the UK. Neurology. 2014;83:e27–33.

    Article  PubMed  Google Scholar 

  22. Lin T-Y, Yang F-C, Lin C-L, Kao C-H, Lo H-Y, Yang T-Y. Herpes zoster infection increases the risk of peripheral arterial disease: a nationwide cohort study. Medicine (Baltimore). 2016;95:e4480.

    Article  Google Scholar 

  23. Chen M-H, Wei H-T, Su T-P, Li C-T, Lin W-C, Chang W-H, et al. Risk of depressive disorder among patients with herpes zoster: a nationwide population-based prospective study. Psychosom Med. 2014;76:285–91.

  24. Hess TM, Lutz LJ, Nauss LA, Lamer TJ. Treatment of acute herpetic neuralgia. A case report and review of the literature. Minn Med. 1990;73:37–40.

    PubMed  CAS  Google Scholar 

  25. Gilden D, White T, Khmeleva N, Boyer PJ, Nagel MA. VZV in biopsy-positive and -negative giant cell arteritis: analysis of 100+ temporal arteries. Neurol Neuroimmunol Neuroinflamm. 2016;3:e216.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Buckingham EM, Foley MA, Grose C, Syed NA, Smith ME, Margolis TP, et al. Identification of herpes zoster-associated temporal arteritis among cases of giant cell arteritis. Am J Ophthalmol. 2018;187:51–60.

  27. Centers for Disease Control and Prevention (CDC). Update on herpes zoster vaccine: licensure for persons aged 50 through 59 years. MMWR Morb Mortal Wkly Rep 2011;60:1528.

  28. •• Shingrix [package insert] [Internet]. GlaxoSmithKline; [cited 2018 Mar 2]. Available from: https://www.fda.gov/downloads/biologicsbloodvaccines/vaccines/approvedproducts/ucm581605.pdf. Shringrix FDA packet insert summarizing indications, contradictions, adverse reactions, and full prescribing information for the zoster recombinant vaccine.

  29. Morrison VA, Johnson GR, Schmader KE, Levin MJ, Zhang JH, Looney DJ, et al. Long-term persistence of zoster vaccine efficacy. Clin Infect Dis. 2015;60:900–9.

  30. Schmader KE, Oxman MN, Levin MJ, Johnson G, Zhang JH, Betts R, et al. Persistence of the efficacy of zoster vaccine in the shingles prevention study and the short-term persistence substudy. Clin Infect Dis. 2012;55:1320–8.

  31. Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, Arbeit RD, Simberkoff MS, Gershon AA, Davis LE, Weinberg A, Boardman KD, Williams HM, Zhang JH, Peduzzi PN, Beisel CE, Morrison VA, Guatelli JC, Brooks PA, Kauffman CA, Pachucki CT, Neuzil KM, Betts RF, Wright PF, Griffin MR, Brunell P, Soto NE, Marques AR, Keay SK, Goodman RP, Cotton DJ, Gnann JW Jr, Loutit J, Holodniy M, Keitel WA, Crawford GE, Yeh SS, Lobo Z, Toney JF, Greenberg RN, Keller PM, Harbecke R, Hayward AR, Irwin MR, Kyriakides TC, Chan CY, Chan IS, Wang WW, Annunziato PW, Silber JL, Shingles Prevention Study Group. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005;352:2271–2284.

  32. • Schmader KE, Levin MJ, Gnann JW, McNeil SA, Vesikari T, Betts RF, et al. Efficacy, safety, and tolerability of herpes zoster vaccine in persons aged 50–59 years. Clin Infect Dis. 2012;54:922–8. Randomized clinical trial that demonstrating that zoster vaccine live (ZVL) reduced the incidence of herpes zoster by 70% in adults aged 50 to 59 years, eventually leading to expansion of FDA labeling of ZVL to include adults 50 to 59 years.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Tyring SK, Diaz-Mitoma F, Padget LG, Nunez M, Poland G, Cassidy WM, Bundick ND, Li J, Chan IS, Stek JE, Annunziato PW, Protocol 009 Study Group. Safety and tolerability of a high-potency zoster vaccine in adults >/= 50 or years of age. Vaccine 2007;25:1877–1883.

  34. Hwang CW, Steigleman WA, Saucedo-Sanchez E, Tuli SS. Reactivation of herpes zoster keratitis in an adult after varicella zoster vaccination. Cornea. 2013;32:508–9.

    Article  PubMed  Google Scholar 

  35. Jastrzebski A, Brownstein S, Ziai S, Saleh S, Lam K, Jackson WB. Reactivation of herpes zoster keratitis with corneal perforation after zoster vaccination. Cornea. 2017;36:740–2.

    Article  PubMed  Google Scholar 

  36. Costa E, Buxton J, Brown J, Templeton KE, Breuer J, Johannessen I. Fatal disseminated varicella zoster infection following zoster vaccination in an immunocompromised patient. BMJ Case Rep. 2016;2016

  37. Charkoudian LD, Kaiser GM, Steinmetz RL, Srivastava SK. Acute retinal necrosis after herpes zoster vaccination. Arch Ophthalmol. 2011;129:1495–7.

  38. Charkoudian LD, Kaiser GM, Steinmetz RL, Srivastava SK. Acute retinal necrosis after herpes zoster vaccination. Arch Ophthalmol. 2011;129:1495–7.

  39. Recommendations for Herpes Zoster Vaccine for Patients 50 Years and Older - 2016 [Internet]. American Academy of Ophthalmology; [cited 2016 Oct 17]. Available from: https://www.aao.org/clinical-statement/recommendations-herpes-zoster-vaccine-patients-50-.

  40. Leading Physician Organizations Call for Shingles Vaccine for People Over 50 [Internet]. [cited 2018 Feb 20]. Available from: https://www.aao.org/newsroom/news-releases/detail/leading-physician-organizations-call-shingles-vacc

  41. Williams WW, Lu P-J, O'Halloran A, Kim DK, Grohskopf LA, Pilishvili T, et al. Surveillance of vaccination coverage among adult populations—United States, 2015. MMWR Surveill Summ. 2017;66:1–28.

    Article  PubMed  PubMed Central  Google Scholar 

  42. La EM, Trantham L, Kurosky SK, Odom D, Aris E, Hogea C. An analysis of factors associated with influenza, pneumoccocal, Tdap, and herpes zoster vaccine uptake in the US adult population and corresponding inter-state variability. Hum Vaccin Immunother. 2018;14:430–41.

    Article  PubMed  Google Scholar 

  43. Dommasch ED, Joyce CJ, Mostaghimi A. Trends in nationwide herpes zoster emergency department utilization from 2006 to 2013. JAMA Dermatol. 2017;153:874–81.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Amirthalingam G, Andrews N, Keel P, Mullett D, Correa A, de Lusignan S, et al. Evaluation of the effect of the herpes zoster vaccination programme 3 years after its introduction in England: a population-based study. Lancet Public Health. 2018;3:e82–90.

  45. Elkin Z, Cohen EJ, Goldberg JD, Gillespie C, Li X, Jung J, et al. Studying physician knowledge, attitudes, and practices regarding the herpes zoster vaccine to address perceived barriers to vaccination. Cornea. 2013;32:976–81.

  46. Elkin ZP, Cohen EJ, Goldberg JD, Li X, Castano E, Gillespie C, et al. Improving adherence to national recommendations for zoster vaccination through simple interventions. Eye Contact Lens. 2014;40:225–31.

  47. Hurley LP, Bridges CB, Harpaz R, Allison MA, O' Leary ST, Crane LA, et al. Physician attitudes toward adult vaccines and other preventive practices, United States, 2012. Public Health Rep 2016;131:320–330.

  48. •• Dooling KL, Guo A, Patel M, Lee GM, Moore K, Belongia EA, et al. Recommendations of the advisory committee on immunization practices for use of herpes zoster vaccines. MMWR Morb Mortal Wkly Rep. 2018;67:103–8. Guidelines of the ACIP of the CDC indicating that the recombinant zoster vaccine is preferred over zoster vaccine live.

    Article  PubMed  PubMed Central  Google Scholar 

  49. • Lal H, Cunningham AL, Godeaux O, Chlibek R, Diez-Domingo J, Hwang S-J, Levin MJ, McElhaney J, Poder A, Puig-Barberà J, Vesikari T, Watanabe D, Weckx L, Zahaf T, Heineman TC, ZOE-50 Study Group. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med 2015;372:2087–2096. Initial randomized clinical trial of recombinant zoster vaccine demonstrating that vaccine efficacy was ~ 97% in all age groups of patients from 50–59, 60–59, and 70 years or older.

  50. Cunningham AL, Lal H, Kovac M, Chlibek R, Hwang S-J, Diez-Domingo J, et al. Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older. N Engl J Med. 2016;375:1019–32.

    Article  PubMed  CAS  Google Scholar 

  51. Neuzil KM, Griffin MR. Preventing shingles and its complications in older persons. N Engl J Med. 2016;375:1079–80.

    Article  PubMed  Google Scholar 

  52. Chlibek R, Smetana J, Pauksens K, Rombo L, Van den Hoek JAR, Richardus JH, et al. Safety and immunogenicity of three different formulations of an adjuvanted varicella-zoster virus subunit candidate vaccine in older adults: a phase II, randomized, controlled study. Vaccine. 2014;32:1745–53.

    Article  PubMed  CAS  Google Scholar 

  53. Chlibek R, Pauksens K, Rombo L, van Rijckevorsel G, Richardus JH, Plassmann G, et al. Long-term immunogenicity and safety of an investigational herpes zoster subunit vaccine in older adults. Vaccine. 2016;34:863–8.

  54. Grupping K, Campora L, Douha M, Heineman TC, Klein NP, Lal H, et al. Immunogenicity and safety of the HZ/su adjuvanted herpes zoster subunit vaccine in adults previously vaccinated with a live attenuated herpes zoster vaccine. J Infect Dis. 2017;216:1343–51.

  55. Godeaux O, Kovac M, Shu D, Grupping K, Campora L, Douha M, et al. Immunogenicity and safety of an adjuvanted herpes zoster subunit candidate vaccine in adults ≥ 50 years of age with a prior history of herpes zoster: a phase III, non-randomized, open-label clinical trial. Hum Vaccin Immunother. 2017;13:1051–8.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Schwarz TF, Aggarwal N, Moeckesch B, Schenkenberger I, Claeys C, Douha M, et al. Immunogenicity and safety of an adjuvanted herpes zoster subunit vaccine coadministered with seasonal influenza vaccine in adults aged 50 years or older. J Infect Dis. 2017;216:1352–61.

  57. Nelson JC, Bittner RCL, Bounds L, Zhao S, Baggs J, Donahue JG, et al. Compliance with multiple-dose vaccine schedules among older children, adolescents, and adults: results from a vaccine safety datalink study. Am J Public Health. 2009;99(Suppl 2):S389–97.

  58. Berkowitz EM, Moyle G, Stellbrink H-J, Schürmann D, Kegg S, Stoll M, et al. Safety and immunogenicity of an adjuvanted herpes zoster subunit candidate vaccine in HIV-infected adults: a phase 1/2a randomized, placebo-controlled study. J Infect Dis. 2015;211:1279–87.

  59. Stadtmauer EA, Sullivan KM, Marty FM, Dadwal SS, Papanicolaou GA, Shea TC, et al. A phase 1/2 study of an adjuvanted varicella-zoster virus subunit vaccine in autologous hematopoietic cell transplant recipients. Blood. 2014;124:2921–9.

  60. Drolet M, Levin MJ, Schmader KE, Johnson R, Oxman MN, Patrick D, et al. Employment related productivity loss associated with herpes zoster and postherpetic neuralgia: a 6-month prospective study. Vaccine. 2012;30:2047–50.

  61. Le P, Rothberg MB. Cost-effectiveness of the adjuvanted herpes zoster subunit vaccine in older adults. JAMA Intern Med. 2018;178:248–58.

    Article  PubMed  Google Scholar 

  62. Bonanni P, Bonaccorsi G, Lorini C, Santomauro F, Tiscione E, Boccalini S, et al. Focusing on the implementation of 21st century vaccines for adults. Vaccine. 2017;

  63. Valente N, Lupi S, Stefanati A, Cova M, Sulcaj N, Piccinni L, et al. Evaluation of the acceptability of a vaccine against herpes zoster in the over 50 years old: an Italian observational study. BMJ Open. 2016;6:e011539.

  64. Jung JJ, Elkin ZP, Li X, Goldberg JD, Edell AR, Cohen MN, et al. Increasing use of the vaccine against zoster through recommendation and administration by ophthalmologists at a city hospital. Am J Ophthalmol. 2013;155:787–95.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Elisabeth J. Cohen.

Ethics declarations

Conflicts of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Ocular Microbiology and Immunology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tsui, E., Cohen, E.J. The Importance of Vaccination Against Herpes Zoster. Curr Ophthalmol Rep 6, 173–180 (2018). https://doi.org/10.1007/s40135-018-0178-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40135-018-0178-z

Keywords

Navigation