Herpes zoster vaccination was previously performed with a live vaccine (attenuated varicella zoster virus strain).Meanwhile, an adjuvanted recombinant split vaccine has been successfully tested for efficacy and safety in a randomized, placebo-controlled phase III trial. As of March 2018, an adjuvanted subunit total vaccine (containing glycoprotein E of the pathogen) has been approved for the prevention of herpes zoster (HZ) and postherpetic neuralgia (PHN) in individuals 50 years of age and older. Herpes zoster (HZ) is the reactivation of a latent (hidden) infection with the varicella zoster virus. This virus causes varicella (chickenpox) in childhood. Herpes zoster can therefore only occur in people who have had chickenpox in their past. Herpes zoster causes a skin rash, which usually occurs only in the area of a dermatome (skin area innervated by a nerve) and causes severe pain. One in four people over the age of 50 will develop herpes zoster in the course of their lives. The following are the recommendations of the Standing Commission on Vaccination (STIKO) at the Robert Koch Institute on herpes zoster vaccination:
Indications (areas of application)
- S: Individuals ≥ 60 years of age
- I: Adults aged 18 years and older at increased risk for HZ (indication extension for herpes zoster (Shingrix) has been approved by the EU Commission)Persons ≥ 50 years of age at increased health risk due to an underlying disease, such as:
- Congenital or acquired immunodeficiency or immunosuppression.
- HIV infection
- Rheumatoid arthritis;
- Systemic lupus erythematosus (SLE).
- Chronic inflammatory bowel disease (IBD).
- Chronic obstructive pulmonary disease (COPD) or bronchial asthma.
- Chronic renal insufficiency
- Diabetes mellitus
Legend
- S: Standard vaccinations with general application.
- I: Indication vaccinations for risk groups with individually (not occupationally) increased risk of exposure, disease or complications and for the protection of third parties.
Contraindications
- Acute diseases requiring treatment
- Immunodeficiencies
- Immunosuppression
- Allergy to vaccine components (see manufacturer’s supplements).
- Pregnancy
Implementation
- Single vaccination with live vaccine; booster after 20-30 years if necessary Note: Vaccination with live herpes zoster vaccine is not recommended as standard vaccination.
- Vaccination twice with adjuvanted herpes zoster live vaccine at intervals of at least 2 to a maximum of 6 months.
- Subcutaneous application
Efficacy
- Live vaccine
- Incidence (frequency of new cases) of herpes zoster: -51%.
- Incidence of postherpetic neuralgia (PHN): -67 %.
- Incidence zoster with severe/long-lasting pain: -73 %.
- Duration/severity of the disease: -61 %.
- SPS study (Shingles Prevention Study): period of 4 years.
- The STPS study (Short-Term Persistence Substudy): minimum period of 5 years.
- LTPS study (Long-Term Persistence Substudy): regarding the incidence of herpes zoster efficacy into the 8th year.
- In contrast, vaccine efficacy decreases with age, ranging from 70% in those aged 50-59 years to 41% in those aged 70-79 years to less than 20% in those aged ≥ 80 years. The duration of protection of the vaccination is documented only for a few years.
- Dead vaccine
- Protective efficacy is 94% (79 to 98%) on a physician-diagnosed herpes zoster; in direct comparison, the new vaccine is 85% (31 to 98%) more effective
- Zoster ophthalmicus (protective effect by 88%; 16 to 100%).
- Postherpetic neuralgia (PHN) (87 versus 66%).
- An observational study showed that people vaccinated against herpes zoster had a 16% lower risk of stroke than unvaccinated controls (incidence: 7.18 vs. 8.45 cases per 1,000 person-years); the risk reduction was greater in people aged 66 to 79 than in older people (20% vs. 10%).
Possible side effects/vaccine reactions
- Mild local reactionsWith the inactivated vaccine, local reactions at the injection site are 79% more common (risk ratio 1.79; 1.05-2.34)
- Mild general reactions; systemic adverse reactions tended to occur more frequently with the inactivated vaccine at 87% (risk ratio of 1.87 was not significant, however, with a 95% confidence interval of 0.88 to 2.96)
- With Shingrix (recombinant adjuvanted herpes zoster vaccine), a higher HZ recurrence rate was found in patients with a history of herpes zoster (HZ) after Shingrix vaccination than would be expected in unvaccinated individuals, according to the package insert.
- Allergic/anaphylactic reactions.
Vaccination status – checking vaccination titers
- Not required
Further notes
- Do not use concurrently with pneumococcal polysaccharide vaccine.
- In England, inclusion of herpes zoster in the vaccination schedule with the Zostavax vaccine for people over 70 years of age resulted in a 35% decrease in herpes zoster disease in the target group within 3 years (relative incidence rate IRR 0.65; 95 percent confidence interval0.60 to 0.72); postherpetic neuralgia (PHN; long-lasting nerve pain after herpes zoster infection) decreased by 38% (IRR 0.62; 0.50-0.79).
