A Vaccine to Prevent Herpes Zoster and Postherpetic Neuralgia in Older Adults
Open accessAbstract
BACKGROUND: The incidence and severity of herpes zoster and postherpetic neuralgia increase with age in association with a progressive decline in cell-mediated immunity to varicella-zoster virus (VZV). We tested the hypothesis that vaccination against VZV would decrease the incidence, severity, or both of herpes zoster and postherpetic neuralgia among older adults. METHODS: We enrolled 38,546 adults 60 years of age or older in a randomized, double-blind, placebo-controlled trial of an investigational live attenuated Oka/Merck VZV vaccine ("zoster vaccine"). Herpes zoster was diagnosed according to clinical and laboratory criteria. The pain and discomfort associated with herpes zoster were measured repeatedly for six months. The primary end point was the burden of illness due to herpes zoster, a measure affected by the incidence, severity, and duration of the associated pain and discomfort. The secondary end point was the incidence of postherpetic neuralgia. RESULTS: More than 95 percent of the subjects continued in the study to its completion, with a median of 3.12 years of surveillance for herpes zoster. A total of 957 confirmed cases of herpes zoster (315 among vaccine recipients and 642 among placebo recipients) and 107 cases of postherpetic neuralgia (27 among vaccine recipients and 80 among placebo recipients) were included in the efficacy analysis. The use of the zoster vaccine reduced the burden of illness due to herpes zoster by 61.1 percent (P<0.001), reduced the incidence of postherpetic neuralgia by 66.5 percent (P<0.001), and reduced the incidence of herpes zoster by 51.3 percent (P<0.001). Reactions at the injection site were more frequent among vaccine recipients but were generally mild. CONCLUSIONS: The zoster vaccine markedly reduced morbidity from herpes zoster and postherpetic neuralgia among older adults.
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The live-attenuated herpes zoster vaccine reduces the incidence of herpes zoster by 51.3% and post-herpetic neuralgia by 66.5% compared to placebo.
“A live-attenuated vaccine is available, which has been shown to reduce the incidence of herpes zoster by 51.3% (95% CI: 44.2–57.6) and of post-herpetic neuralgia, a severe complication occurring frequently in the elderly, by 66.5% (95% CI: 44.5–79.2) in the vaccinated population compared to placebo [170].”
From Aging of the immune system: Focus on inflammation and vaccination (2016) · cites this paper as [170]
The protective effect of the live-attenuated herpes zoster vaccine against post-herpetic neuralgia was independent of age, whereas clinical efficacy against herpes zoster declined to 27.6% in persons older than 69 years.
“The protective effect against post-herpetic neuralgia was independent of age, whereas clinical efficacy against herpes zoster declined to only 27.6% in persons older than 69 years.”
From Aging of the immune system: Focus on inflammation and vaccination (2016) · cites this paper as [170]
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- Authors
- Oxman, M. N., Levin, M. J., Johnson, G. R., Schmader, K. E., Straus, S. E., Gelb, L. D., Arbeit, R. D., Simberkoff, M. S., Gershon, A. A., Davis, L. E., Weinberg, A., Boardman, K. D., Williams, H. M., Zhang, J. H., Peduzzi, P. N., Beisel, C. E., Morrison, V. A., Guatelli, J. C., Brooks, P. A., Kauffman, C. A., Pachucki, C. T., Neuzil, K. M., Betts, R. F., Wright, P. F., Griffin, M. R., Brunell, P., Soto, N. E., Marques, A. R., Keay, S. K., Goodman, R. P., Cotton, D. J., Gnann, J. W., Loutit, J., Holodniy, M., Keitel, W. A., Crawford, G. E., Yeh, S.-S., Lobo, Z., Toney, J. F., Greenberg, R. N., Keller, P. M., Harbecke, R., Hayward, A. R., Irwin, M. R., Kyriakides, T. C., Chan, C. Y., Chan, I. S. F., Wang, W. W. B., Annunziato, P. W., & Silber, J. L.
- Affiliations
- University of California San Diego (US)
- Durham VA Medical Center (US)
- Duke Medical Center (US)
- National Institutes of Health (US)
- Washington University in St. Louis (US)
- VA Boston Healthcare System (US)
- VA NY Harbor Healthcare System (US)
- Columbia University (US)
- New Mexico VA Health Care System (US)
- National Institute of Allergy and Infectious Diseases (US)
- VA San Diego Healthcare System (US)
- VA Ann Arbor Healthcare System (US)
- Edward Hines, Jr. VA Hospital (US)
- VA Puget Sound Health Care System (US)
- University of Rochester Medicine (US)
- Vanderbilt University Medical Center (US)
- Baltimore VA Medical Center (US)
- VA Palo Alto Health Care System (US)
- Baylor College of Medicine (US)
- The University of Texas at San Antonio Health Science Center (US)
- Northport VA Medical Center (US)
- James A. Haley Veterans' Hospital (US)
- Lexington VA Health Care System (US)
- University of California, Los Angeles (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2005-06-02
- Volume
- 352
- Issue
- 22
- Pages
- 2271-2284
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2131041950
- Cited by
- 2,412
- References
- 40
- Citations by year
- 2026: 51 · 2025: 90 · 2024: 63 · 2023: 92 · 2022: 60 · 2021: 95 · 2020: 97 · 2019: 111 · 2018: 145 · 2017: 155 · 2016: 158 · 2015: 133 · 2014: 126 · 2013: 149 · 2012: 110
- FWCI
- 89.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Office of Research and Development
- Topics
- Health Sciences › Medicine › Epidemiology › Herpesvirus Infections and Treatments
- Health Sciences › Medicine › Epidemiology › Cytomegalovirus and herpesvirus research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
- Keywords
- herpes zoster, postherpetic neuralgia, varicella-zoster virus, live attenuated zoster vaccine, older adults, vaccine efficacy, disease burden, cell-mediated immunity, injection site reactions
- MeSH terms
- Aged, Double-Blind Method, Female, Follow-Up Studies, Herpes Zoster, Humans, Immunologic Memory, Male, Middle Aged, Neuralgia, Vaccines, Attenuated, Herpesvirus 3, Human, Virus Activation, Incidence, Cost of Illness, Chickenpox Vaccine
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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