ZOSTAVAX is indicated for the prevention of herpes zoster (shingles) in people 60 years of age and older. The United States experiences over a million herpes zoster cases each year.1,2 VZV has been studied for years, beginning in 1875 when the infectious nature of the attendant diseases was first revealed.3 In 1943, researchers hypothesized that shingles could be due to a reactivation of an earlier exposure.3 Then, in 1986, investigators decoded the VZV genome,4 leading to a varicella vaccine in 1995 and, more recently, a zoster vaccine in 2007.5 But the vaccine has not received the wide acceptance everyone anticipated, even though the virus is of considerable concern for many doctors. Boosting immunological memory is the key strategy for keeping the latent varicella zoster virus infection under control. In national television and magazine ads, Merck has been urging people aged 50 and over to get protected against herpes zoster (shingles) by being vaccinated with Zostavax. Food and Drug Administration recommends a vaccine for shingles for people older than 60, but not for individuals taking anti-tumor necrosis factor therapies or other biologics commonly used to treat immune-mediated diseases. None of the 633 patients who were taking biologics (including 551 taking anti-tumour necrosis factor [TNF] biologics) had varicella or HZ during the 42 days immediately after vaccination. Additional benefit was afforded to vaccine recipients who developed zoster by reduction in the incidence of PHN: 5% for those 60-69 years of age, 55% for those 70-79 years of age, and 26% for those 80 years and older.
The researchers measured the incidence rate of herpes zoster within 42 days after vaccination (a safety concern) and beyond 42 days. “ZOSTAVAX is the only medical option approved for the prevention of shingles and represents a major public health advance for people age 60 and older,” said Mark Feinberg, M.D., Ph.D., vice president of Policy, Public Health and Medical Affairs, Merck Vaccines. He said that in healthy individuals over 60, the vaccine was very effective and cut the risk of contracting shingles by half. The researchers found that among 633 patients exposed to biologics, including 551 patients exposed to anti-tumor necrosis factor (TNF) biologics, no cases of varicella or HZ occurred within the 42 days following vaccination. Among all patients, only 1 case of primary varicella was identified within the 42-day risk window, occurring on day 10 after vaccination. During the period of more than 42 days after vaccination, the researchers observed 138 HZ cases. After controlling for demographics, type of immune-mediated disease, health care utilization, and exposure to biologic and nonbiologic disease-modifying antirheumatic drugs (DMARDs) and oral glucocorticoids, data indicated that vaccination was associated with decreased HZ risk over a median of 2 years of follow-up.
“Despite the recognition that patients with immune-mediated conditions are at increased risk of HZ, this and previous studies have shown that only a small fraction of these patients received the vaccine, likely in part due to safety concerns. ZOSTAVAX is also contraindicated in persons on immunosuppressive therapy. Even decades after HZO infection, the eye and adnexal tissue never return to their original state. At the age of 60 years and older there is an eight- to ten-times higher likelihood of developing herpes zoster compared with the younger population . NACI recommends all adults over 60 receive one dose of Zostavax. Curtis received support from AHRQ and the National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.
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