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Varicella Vaccine Reduces Herpes Zoster Morbidity in Older Adults

In a large trial among older adults, a new varicella vaccine significantly reduced morbidity from herpes zoster and postherpetic neuralgia.

Waning cell-mediated immunity to varicella-zoster virus (VZV) is associated with an increased incidence of herpes zoster in older individuals. In a prospective, multicenter, randomized, controlled trial that was partially supported by industry, investigators tested whether administration of a live attenuated VZV vaccine to older adults might boost their immunity against VZV and prevent the development of zoster.

From November 1998 through September 2001, 38,546 immunocompetent subjects 60 years old received a single dose of VZV vaccine or placebo; follow-up continued through April 2004 (mean duration, 3.1 years). Compared with control subjects, vaccine recipients showed significant reductions in incidence (5.4 vs. 11.1 episodes per 1000 person-years, respectively), duration, and severity of herpes zoster, overall burden of illness from the condition, and incidence of postherpetic neuralgia (0.46 vs. 1.38 episodes per 1000 person-years). Side effects during the first 42 postimmunization days (mostly minor injection-site reactions) were more common in vaccine recipients than in controls (58% vs. 34%). Among the 957 participants who developed herpes zoster, PCR testing detected wild-type VZV DNA in 894 and vaccine-virus DNA in none.

Comment: Given the morbidity associated with herpes zoster, the VZV vaccine's ability to reduce disease incidence by >50% and postherpetic neuralgia incidence by 66.5% strongly suggests that it could produce a major benefit for older adults. As noted by an editorialist, vaccination would likely be quite cost-effective. The VZV vaccine employed in this trial was about 14-fold more potent than the preparation currently licensed for children, so this formulation will require FDA approval.

— Richard T. Ellison III, MD

Published in Journal Watch Infectious Diseases June 24, 2005

Citation(s):

Oxman MN et al. A vaccine to prevent herpes zoster and postherpetic neuralagia in older adults. N Engl J Med 2005 Jun 2; 352:2271-84.

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• Medline abstract (Free)

Gilden DH. Varicella-zoster virus vaccine — Grown-ups need it, too. N Engl J Med 2005 Jun 2; 352:2344-6.

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• Medline abstract (Free)