Efficacy of live zoster vaccine in preventing zoster and postherpetic neuralgia

Authors


Don Gilden, MD, Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Box B182, Aurora, CO 80045, USA.
(fax: 303 724 4329; e-mail: don.gilden@ucdenver.edu).

Abstract

Abstract.  Gilden D (University of Colorado School of Medicine, Aurora, CO, USA). Efficacy of live zoster vaccine in preventing zoster and postherpetic neuralgia (Review). J Intern Med 2011; 269: 496–506.

Declining cell-mediated immunity to varicella zoster virus (VZV) in elderly individuals results in virus reactivation manifest by zoster (shingles) and postherpetic neuralgia (PHN). To prevent virus reactivation, a new VZV vaccine (Zostavax; Merck) that boosts cell-mediated immunity to VZV was developed. The 3-year Shingles Prevention Study showed that Zostavax significantly reduced burden of disease because of zoster and PHN. Despite its cost-effectiveness for adults aged 65–75 years, as determined in the United States, Canada and UK, <2% of immunocompetent adults over age 60 years in the United States were immunized in 2007. This was because of a combination of lack of patient awareness of the vaccine, physicians’ uncertainty about the duration of protection and different cost-sharing plans for immunization. Nevertheless, zoster vaccine is safe, effective and highly recommended for immunization of immunocompetent individuals over age 60 years with no history of recent zoster.

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