Zostavax® for the prevention of herpes zoster and postherpetic neuralagia. Pilot assessment using the draft HTA Core Model for Rapid Relative Effectiveness Assessment.

Zostavax® for the prevention of herpes zoster and postherpetic neuralagia. Pilot assessment using the draft HTA Core Model for Rapid Relative Effectiveness Assessment.

BACKGROUND: Despite the perspective of vaccination against herpes zoster, there are few recent data available on the incidence of this disease, the proportion of postherpetic neuralgia cases, and associated disease management costs. Circulating T cells, which proliferated in vitro in response to VZV antigen, were enumerated (VZV responder cell frequency assay). Herpes zoster (HZ) is common and often severe in patients undergoing chemotherapy, yet there are no data regarding whether these patients retain specific protection against HZ if they had previously received zoster vaccine. In the acute phase, pain is usually moderate or severe, with patients ranking HZ pain as more intense than post-surgical or labour pains. * Number and percentage of participants reporting at least one adverse event (AE )† specific descriptions were required for rashes, including number and type of lesion, location (injection-site or non-injection-site) and confirmation of diagnosis. Second, the acute pain and rash caused by herpes zoster and possibly postherpetic neuralgia 4,8 may be relieved by aggressive treatment with antivirals (famciclovir, valacyclovir) within 72 hours after the onset of the rash (or even at the stage of acute, segmental, neuropathic pain [burning or shock-like] in the forehead or midthorax, which often precedes the rash). Transition probabilities were based on HZ/PHN-epidemiology and demographic data from Germany, as well as vaccine efficacy (VE) data from clinical trials.

Zostavax® for the prevention of herpes zoster and postherpetic neuralagia. Pilot assessment using the draft HTA Core Model for Rapid Relative Effectiveness Assessment.
VZV glycoprotein E was selected as a candidate vaccine antigen. Results. Of the topical therapies, the topical lidocaine 5 % patch has proven more effective than capsaicin cream or 8 % patch and has a more rapid onset of action than the other first-line therapies or capsaicin. Result: On average 50 persons aged 50+ must be vaccinated to prevent one new case of Herpes Zoster. The mean EQ-5D score was 0.59 at enrolment and remained at 0.67 at all follow-up points among participants who reported clinically significant pain. Whether the vaccine reduces postherpetic neuralgia in all age Groups, in those who develop Herpes Zoster despite vaccination, is unclear. Studies did not show a clinically relevant reduction in pain, and whether activities of daily living or health-related quality of life are improved by the vaccine is unknown, because of lack of evidence.

Overall mortality and hospital admissions have not been reduced with the vaccination in the studies. The most common side effects are injection-site related adverse events. They have occurred more frequently in vaccinated people than in the control groups. The risk of developing severe adverse events increases with age and was also higher in vaccinated people, particularly in people over 80 years. Standard safety testing for adventitious agents, however, was performed on primates and other laboratory animals. Whether patient relevant benefits are achieved (e.g. pain) is currently unclear.

Overall mortality and hospital admissions on a population level won’t be reduced with vaccination. Therefore, there are opportunities to vaccinate these persons before they become immunocompromised.

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