Cochrane reviews – in their own words
Vaccines for preventing herpes zoster in older adults
Version of Record online: 29 NOV 2012
© 2012 Wiley Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University
Journal of Evidence-Based Medicine
Volume 5, Issue 4, page 240, November 2012
How to Cite
Gagliardi, A. (2012), Vaccines for preventing herpes zoster in older adults. Journal of Evidence-Based Medicine, 5: 240. doi: 10.1111/jebm.12008
- Issue online: 29 NOV 2012
- Version of Record online: 29 NOV 2012
- Accepted manuscript online: 7 NOV 2012 12:27PM EST
Herpes Zoster or shingles is a neurocutaneous disease characterized by the reactivation of the zoster varicella virus, which is the same virus responsible for chickenpox or varicella. When the chickenpox episode is over, the virus can remain dormant inside nerves in a person's spine, with its replication inhibited by the specific immunity that the person acquired. However, if that immunity declines for any reason, the virus may reactivate and travel to the skin surface, producing clusters of blisters along the path of the affected nerve, a condition called herpes zoster.
This can be an extremely painful disease, with symptoms such as itching, numbness, tingling or localised pain, which can precede the appearance of the skin lesions. The severe pain that some patients suffer arises from inflammation of sensory nerves, and this, as well as the other symptoms, can have an important impact on patients’ quality of life.
As people get older, their specific immunity to the varicella zoster virus tends to decline, leaving the way open for viral replication and this predisposes elderly people to develop this disease. The older the person, the higher the incidence of herpes zoster. Among people over 65 years the incidence is above 100 per 10,000 people, raising to about 125 per 10,000 over 70 years and 137 per 10,000 for people in their 80s.
Our Cochrane Review looks at one of the ways to prevent this. We evaluate the effectiveness and safety of a live attenuated VZV vaccine subcutaneous injection, which is used to prevent herpes zoster in older adults, and finding strong evidence of benefit.
We identified 8 randomised trials with more than 52,000 healthy participants, although the bulk of these, around 38,000 people, were in one study which also had the longest follow up at 3 or more years for the participants. This demonstrated that vaccinating elderly people reduces the incidence of herpes zoster over this time period, at least, with no major safety/tolerability concerns. For every 50 people vaccinated, one fewer developed herpes zoster. Some uncertainties remain, which need to be investigated in future research. This should look at lower concentrations of virus as well as different routes of administration of the vaccine, and the effects in people in their 50s and of other races.