Zoster vaccine

Herpes zoster vaccine is a live attenuated vaccine to prevent herpes zoster in patients over the age of 60 years.

May cause extensive rash or disseminated disease in immunosuppressed patients.

Use in patients with previous shingles has not been tested.

In the US incidence rate of herpes zoster (HZ) in unvaccinated general population 50 years or older is estimated to be 7 cases per 1000-person years (Insinga RP et al).

Decreased the risk of developing shingles by 51% compared to placebo at a median duration of 3.1 years.

Live attenuated virus reduces HZ risk by 70% and 51% among immunocompetent individuals 50-59 years and 60 years and older in 2 randomized trials, respectively ((Schmager KE et al, Oxman MN et al).

Efficacy highest for patients 60-69 years of age and declines with increasing age.

Patients with the previous episode of herpes zoster can be vaccinated if there are no contraindications to the vaccine.

Associated with a 55% reduction in the incidence of herpes zoster, decreased the risk of ophthalmic herpes zoster, and suggested one episode of herpes zoster would be averted for every 71 individuals receiving the vaccine (Tseng HF et al).

Reduces incidence of postherpetic neuralgia in individuals who develop shingles by 39% compared to the placebo group.

1.4% experience headaches, injection site reactions of erythema 33%, pain/tenderness 33%, swelling 25%, hematoma 1.4% itching 6.6% and warmth 1.5%.

Contraindicated in leukemia, lymphomas, other bone marrow malignancies, AIDS, untreated tuberculosis, immunosuppressed patients, patients on high dose corticosteroids and in women who are or may be pregnant.

The live attenuated HZ vaccine is contraindicated in those taking anti-tumor necrosis factor treatments or biologic agents and should be administered before receiving these medications.

In a study of 463,541 patients 60 years or older with rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, or inflammatory bowel disease, herpes zoster vaccine was not associated in the short-term with an increase in herpes zoster(Zhang J et al).

In the above study patients treated with biologics and other drugs for their immune mediated diseases that were vaccinated also did not have an increased incidence of herpes zoster.

In the above population the vaccine was associated with alower herpes zoster incidence over the median of 2 years.of two years of follow-up.

Not a substitute for varicella virus vaccine and should not be used in children.

Recommended: a single dose of zoster vaccine for all people 60 years or older.

Zostavax is the live attenuated vaccine against heroes zoster discussed above.

The live-attenuated vaccine against herpes zoster’s efficacy decreases with age from 69.8% in adults from the ages of 50 -59 to 37.6% for those greater than 70 years of age, and is contraindicated in patients with immunosuppression.

Recombinant subunit vaccines are an alternative to live attenuated vaccines and may be suitable for persons with immunosuppression because the risk of disease resulting from replication of the vaccine virus is prevented.

A recombinant subunit vaccine containing VZV glycoprotein E and AS01b adjuvant system utilized for the prevention of herpesviruses in older adults:

It significantly reduced the risk of herpes zoster in adults with 50 years of age or older and its efficacy in adults who are 70 years of age or older was similar to that in the other two age groups.

Herpes zoster subunit vaccine had an overall efficacy against herpes zoster of 97.2%(Lal, H et al).

Herpes zoster subunit vaccine phase three trial study participants were not immunocompromised, 50 years of age or older.

Efficacy of the vaccine did not diminish with increasing and it was 96.6 percent among participants between 50 and 59 years, 97.4% among those ages 60-69 years and 97.9 in those 70 years of age or older.

Tradename Shingix.

Approved for adults at least 50 years of age.

Recombinant zoster vaccine produced by a combination of recombinant subunit varicella zoster glycoprotein E and a liposome based adjuvant.

Recombinant zoster vaccine administered in 2 doses, the second 2-6 months after the first.

Trials show preventioon efficacy of recombinant zoster vaccine 92% and a postherpetic neuralgia prevention efficacy of 89%.

Efficacy rates with recombinant zoster vaccine similar for individuals over the age of 70 as for younger adults.

Recombinant zoster vaccine is more effective and less expensive than live-attenuated zoster vaccine at $280 for the 2 injection series.

Recombinant ZV recommended for immunocompetent patients or those who are receiving mildly immunosuppressive treatment, as well as individuals anticipating immunosuppression or have recovered from an immunocompromising illness.

Being studied in immunocompromised patients.

Recombinant herpes zoster vaccine reduced the incidence of herpes zoster in autologous stem cell transplant recipients.

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