Vaccine reduces zoster in real-world practice

The herpes zoster vaccine reduced the incidence of the disease by 55% in real-world clinical practice, according to a recent report.

This finding, from a retrospective cohort study of more than 303,000 healthy, community-dwelling adults aged 60 years and older, confirms and extends the results of clinical trials that found the vaccine effective under idealized conditions. The cohort study also found further benefits that had not been shown before: The herpes zoster vaccine also decreased the rate of ophthalmic herpes and was effective in patients with underlying chronic diseases that were feared to interfere with immune function.

Thus, the benefits of the vaccine extend to the ophthalmic manifestation of the disease, to all races, both genders, and all ages over 60, as well as to patients with chronic illness according to the Southern California Kaiser Permanente, Pasadena.

These results are particularly important given that “herpes zoster vaccine uptake has been poor due to weaknesses in the adult vaccine infrastructure and also due to serious barriers to the vaccine among clinicians and patients.

Solution to these challenges need to be found so that individuals seeking to receive herpes zoster vaccine will be able to reduce their risk of experiencing this serious condition.

They assessed the vaccine’s effectiveness in 75,761 California patients in the managed care plans who were immunized in 2007-2009, comparing outcomes with those of 227,283 age matched control subjects who were not vaccinated. A total of 5,434 cases of herpes zoster developed during an average follow-up of 1 to 2 years.

The incidence of herpes zoster was 6.4 per 1,000 person-years in control group. This reflects a 55% reduction in incidence with vaccine. This result indicates that 1 episode of herpes zoster would be averted for every 71 patents receiving the vaccine.

The vaccine benefits persisted across all subgroups of patients, particularly in the oldest subjects. Our results support recommendation to offer herpes zoster vaccine to eligible patients of all ages, including the oldest population.

For the oldest group, this could translate into a very large absolute reduction in disease because they bear the greatest burden of herpes zoster and postherpetic neuralgia and are also especially vulnerable to these disabling conditions.

The vaccine’s effectiveness against ophthalmic herpes is an important finding not reported previously. Ophthalmic involvement is common and can lead to serious vision-threatening sequelae.

The finding that the vaccine also was effective in patients with chronic underlying disease was “reassuring” because these disease might have interfered with functional immunity and vaccine effectiveness.