February 06, 2018
By Will Boggs MD
NEW YORK (Reuters Health) - The new recombinant zoster vaccine (RZV) is favored over the live attenuated zoster vaccine live (ZVL) for preventing herpes zoster infection and related complications for most adults age 50 or older, according to the latest Advisory Committee on Immunization Practices (ACIP) recommendations.
"Healthcare providers now have a new and highly effective tool to prevent shingles and its complications,” Dr. Kathleen L. Dooling from the Centers for Disease Control and Prevention (CDC)'s National Center for Immunization and Respiratory Disease, Atlanta, Georgia, told Reuters Health by email. “The recombinant zoster vaccine is over 90% effective, even among the elderly.”
Dr. Dooling and colleagues outline recent ACIP recommendations, as well as guidance for use of RZV and ZVL in adults, online January 26 in Morbidity and Mortality Weekly Report.
The new RZV consists of two intramuscular doses administered 2 to 6 months apart (and at least 2 months after getting ZVL in individuals who have received that vaccine).
The reported efficacy of RZV for preventing herpes zoster exceeds 90% for all age groups, higher than the efficacy reported for ZVL.
Under most assumptions, vaccination with RZV prevented more disease at lower overall costs than did vaccination with ZVL, according to the CDC cost-effectiveness analysis.
RZV - which is expected to provide substantial protection against herpes zoster beyond 4 years - is appropriate for people with a history of herpes zoster, people with chronic medical conditions, and individuals who take low-dose immunosuppressive therapy or who have recovered from an immunocompromising illness.
ACIP currently makes no recommendations on the use of RZV in immunocompromised persons or pregnant or lactating women.
“For people who are immunocompromised, studies are underway, and we anticipate ACIP will consider use of RZV in this population as data become available over the coming months,” Dr. Dooling said.
“Pregnant and lactating women, on the other hand, have generally not been included in clinical trials,” she said. “For the currently recommended ages - 50 and older - CDC guidance suggests delaying vaccination until a woman is no longer pregnant or breastfeeding. Pregnancy and breastfeeding are relatively rare in this age group, and there are no planned clinical studies to establish safety.”
Dr. Dooling said, “The recombinant zoster vaccine frequently leads to short-term side effects, such as pain, redness, or swelling where the vaccine was administered or general muscle aches and fatigue. It is important for patients and providers to be aware of and expect these side effects. For most people, the side effects went away in 2 to 3 days. However, for about 1 in 6 people, (they) were severe enough to briefly prevent their regular activities.”
“ZVL remains a recommended vaccine for the prevention of herpes zoster,” she said. “ZVL may be used in instances such as if the patient is allergic to RZV or if RZV is unavailable.”
Dr. Phuc Le from Cleveland Clinic, in Ohio, who recently reviewed new developments in the prevention of herpes zoster, told Reuters Health by email, "RZV really is superior to ZVL and represents good value. Even though it costs more, the vaccine is worth it for the extra protection against herpes zoster, especially for patients over 70 years of age.”
“However,” she said, “if physicians do prescribe RZV, they need to emphasize to patients the importance of completing the series and make sure their patients actually get both doses.”
Dr. Anthony L. Cunningham from the University of Sydney, in Australia, who has evaluated various aspects of herpes zoster vaccines, told Reuters Health by email, "With good compliance, I can't think of any setting where ZVL would be preferred, given the much higher efficacy of RZV.”
“Post-herpetic neuralgia is nasty and increases in incidence over the age of 60,” he said. “All immunocompetent people over this age should consider having RZV. Even though we don't know exactly how long it will last, the immunogenicity persists for >9 years.”
Dr. Cunningham added, “People who have had ZVL >5 years ago should seriously consider having RZV as a booster.”
Morbid Mortal Wkly Rep MMWR 2018.
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