Herpes Zoster Vaccination: Controversies and Common Clinical Questions.

Herpes Zoster Vaccination: Controversies and Common Clinical Questions.

Unfortunately, many Malaysians hold the assumption that one can only be infected by the chickenpox virus once in their life time, said Datuk Dr Christopher Lee who is Hospital Sungai Buloh’s Head and Senior Consultant Physician at the Infectious Disease Unit. Shingles (AKA herpes zoster) is an exquisitely painful condition, the pain of which can linger for years in the form of postherpetic neurlagia. Direct costs and Quality-Adjusted Life-Year (QALY) losses were estimated as a function of standardised Severity Of Illness (SOI) scores (i.e. According to the National Vaccine Information Center (NVIC),1 shingles is more common in individuals over age 50, although those who are immunocompromised are also at risk. Although the infection presents with a rash, commonly fairly painful, it usually subsides within three to five weeks. Both societal and payer perspectives were considered. Centers for Disease Control and Prevention (CDC).

Herpes Zoster Vaccination: Controversies and Common Clinical Questions.
Systematic review of models assessing the economic value of routine varicella and herpes zoster vaccination in high-income countries. Microbiol., 50 (1996), 59–100. Our findings support the decision of the Advisory Committee on Immunization Practices not to recommend the vaccine for adults in this age group. Randomised controlled trials (RCTs) or quasi-RCTs comparing zoster vaccine with placebo or no vaccine, to prevent herpes zoster in older adults (mean age > 60 years). The findings are also sensitive to a number of parameters that are inaccurately quantified, such as the risk of HZ in varicella vaccine responders. Vaccination against this virus is also recommended for children8. The main efficacy parameters were the proportion of vaccinees who responded (vaccine take) and the decline in vaccine efficacy with time (vaccine wane).

The largest study included 38,546 participants. Vaccination strategies will likely need to be adjusted as the epidemiology of VZV and risk factors continues to evolve [33]. The fatality rate of bacteremic pneumococcal pneumonia is 5% to 7% and is higher among elderly persons. Three studies tested a new type of vaccine not yet available for clinical use. We judged five of the included studies to be at low risk of bias.The incidence of herpes zoster, at up to three years of follow-up, was lower in participants who received the vaccine than in those who received a placebo: risk ratio (RR) 0.49; 95% confidence interval (CI) 0.43 to 0.56, risk difference (RD) 2%, number needed to treat to benefit (NNTB) 50; GRADE: moderate quality evidence. The vaccinated group had a higher incidence of mild to moderate intensity adverse events. These date came from one large study that included 38,546 people aged 60 years or older.A study including 8122 participants compared the new vaccine (not yet available) to the placebo; the group that received the new vaccine had a lower incidence of herpes zoster at 3.2 years of follow-up: RR 0.04, 95% CI 0.02 to 0.10, RD 3%, NNTB 33; GRADE: moderate quality evidence.

The vaccinated group had a higher incidence of adverse events but most them were of mild to moderate intensity.All studies received funding from the pharmaceutical industry. The vaccine cost is $200 (with no admin fee, no dispensing fee, and no injection fee on top of this cost). In general, zoster vaccine is well tolerated; it produces few systemic adverse events and injection site adverse events of mild to moderate intensity.There are studies of a new vaccine (with a VZV glycoproteic fraction plus adjuvant), which is currently not yet available for clinical use.

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