The Importance of Vaccination Against Herpes Zoster
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.
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.
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.
KeywordsHerpes zoster Shingles Vaccination Herpes zoster ophthalmicus Zoster vaccine live Zostavax HZ subunit vaccine Recombinant zoster vaccine Shingrix
Compliance with Ethical Standards
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.
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.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.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.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.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.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.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.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.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 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. CrossRefPubMedPubMedCentralGoogle 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.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;2016Google Scholar
- 37.Charkoudian LD, Kaiser GM, Steinmetz RL, Srivastava SK. Acute retinal necrosis after herpes zoster vaccination. Arch Ophthalmol. 2011;129:1495–7.Google Scholar
- 38.Charkoudian LD, Kaiser GM, Steinmetz RL, Srivastava SK. Acute retinal necrosis after herpes zoster vaccination. Arch Ophthalmol. 2011;129:1495–7.Google Scholar
- 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
- 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.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 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. CrossRefPubMedPubMedCentralGoogle 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. 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.CrossRefPubMedGoogle 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.Google Scholar
- 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.Google Scholar
- 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.CrossRefPubMedPubMedCentralGoogle 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.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 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.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;Google Scholar
- 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.Google Scholar
- 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.Google Scholar