Herpes Zoster Vaccination: A Vaccine to Prevent Pain

  • Robert JohnsonEmail author
Part of the Practical Issues in Geriatrics book series (PIG)


The varicella zoster virus (VZV) is an alpha herpesvirus that forms latency and can reactivate to cause a second infection. Reactivation occurs in the form of herpes zoster (HZ), commonly known as “shingles”. In younger patients, shingles is often a painful, dermatomal, rash that lasts 10–20 days and is usually followed by full recovery, albeit with the possibility of some hypo- or hyperpigmentation. The incidence and severity of HZ increases with age, particularly beyond 60 and 70 years of age, with rates of approximately 3.2/1000 person-years overall and up to 10/1000 person-years above 80 years. In older and immunocompromised patients, post-herpetic neuralgia (PHN) is a common complication, defined as clinically significant pain occurring or persisting at or beyond 90 days after HZ rash appearance. The main predictors for PHN are greater disease severity (pain and rash) and older age, while other factors such as female sex or immunosuppression have also been found to be associated with an increased risk. Functional ability declines with age, and HZ and PHN may accelerate this decline, and many patients will never regain the level of functioning appropriate for their age. Herpes zoster can be effectively prevented by vaccination.


Vaccination Varicella zoster virus Herpes zoster Shingles Post-herpetic neuralgia 


  1. 1.
    Sengupta N, Booy R, Schmitt HJ, Peltola H, Van-Damme P, Schumacher RF, et al. Varicella vaccination in Europe: are we ready for a universal childhood programme? Eur J Pediatr. 2008;167(1):47–55.CrossRefGoogle Scholar
  2. 2.
    Gauthier A, Breuer J, Carrington D, Martin M, Remy V. Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United Kingdom. Epidemiol Infect. 2009;137(1):38–47.CrossRefGoogle Scholar
  3. 3.
    Stein AN, Britt H, Harrison C, Conway EL, Cunningham A, Macintyre CR. Herpes zoster burden of illness and health care resource utilisation in the Australian population aged 50 years and older. Vaccine. 2009;27(4):520–9.CrossRefGoogle Scholar
  4. 4.
    Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc. 2007;82(11):1341–9.CrossRefGoogle Scholar
  5. 5.
    Lu PJ, Euler GL, Harpaz R. Herpes zoster vaccination among adults aged 60 years and older, in the U.S., 2008. Am J Prev Med. 2011;40(2):e1–6.CrossRefGoogle Scholar
  6. 6.
    Aspinall R, Del Giudice G, Effros RB, Grubeck-Loebenstein B, Sambhara S. Challenges for vaccination in the elderly. Immun Ageing. 2007;4:9.CrossRefGoogle Scholar
  7. 7.
    Caruso C, Buffa S, Candore G, Colonna-Romano G, Dunn-Walters D, Kipling D, et al. Mechanisms of immunosenescence. Immun Ageing. 2009;6:10.CrossRefGoogle Scholar
  8. 8.
    Kumar R, Burns EA. Age-related decline in immunity: implications for vaccine responsiveness. Expert Rev Vaccines. 2008;7(4):467–79.CrossRefGoogle Scholar
  9. 9.
    Boraschi D, Del Giudice G, Dutel C, Ivanoff B, Rappuoli R, Grubeck-Loebenstein B. Ageing and immunity: addressing immune senescence to ensure healthy ageing. Vaccine. 2010;28(21):3627–31.CrossRefGoogle Scholar
  10. 10.
    Hansson E, Forbes HJ, Langan SM, Smeeth L, Bhaskaran K. Herpes zoster risk after 21 specific cancers: population-based case-control study. Br J Cancer. 2017;116(12):1643–51.CrossRefGoogle Scholar
  11. 11.
    Kawai K, Gebremeskel BG, Acosta CJ. Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open. 2014;4(6):e004833.CrossRefGoogle Scholar
  12. 12.
    Shiraki K, Toyama N, Daikoku T, Yajima M, Miyazaki Dermatologist S. Herpes zoster and recurrent herpes zoster. Open Forum Infect Dis. 2017;4(1):ofx007.CrossRefGoogle Scholar
  13. 13.
    Yawn BP, Wollan PC, Kurland MJ, St Sauver JL, Saddier P. Herpes zoster recurrences more frequent than previously reported. Mayo Clin Proc. 2011;86(2):88–93.CrossRefGoogle Scholar
  14. 14.
    Helgason S, Petursson G, Gudmundsson S, Sigurdsson JA. Prevalence of postherpetic neuralgia after a first episode of herpes zoster: prospective study with long term follow up. BMJ. 2000;321(7264):794–6.CrossRefGoogle Scholar
  15. 15.
    Gialloreti LE, Merito M, Pezzotti P, Naldi L, Gatti A, Beillat M, et al. Epidemiology and economic burden of herpes zoster and post-herpetic neuralgia in Italy: a retrospective, population-based study. BMC Infect Dis. 2010;10:230.CrossRefGoogle Scholar
  16. 16.
    Opstelten W, Mauritz JW, de Wit NJ, van Wijck AJ, Stalman WA, van Essen GA. Herpes zoster and postherpetic neuralgia: incidence and risk indicators using a general practice research database. Fam Pract. 2002;19(5):471–5.CrossRefGoogle Scholar
  17. 17.
    Ultsch B, Koster I, Reinhold T, Siedler A, Krause G, Icks A, et al. Epidemiology and cost of herpes zoster and postherpetic neuralgia in Germany. Eur J Health Econ. 2013;14(6):1015–26.CrossRefGoogle Scholar
  18. 18.
    Weitzman D, Shavit O, Stein M, Cohen R, Chodick G, Shalev V. A population based study of the epidemiology of Herpes Zoster and its complications. J Infect. 2013;67(5):463–9.CrossRefGoogle Scholar
  19. 19.
    Yawn BP, Gilden D. The global epidemiology of herpes zoster. Neurology. 2013;81(10):928–30.CrossRefGoogle Scholar
  20. 20.
    Meister W, Neiss A, Gross G, Doerr HW, Hobel W, Malin JP, et al. A prognostic score for postherpetic neuralgia in ambulatory patients. Infection. 1998;26(6):359–63.CrossRefGoogle Scholar
  21. 21.
    Forbes HJ, Bhaskaran K, Thomas SL, Smeeth L, Clayton T, Mansfield K, et al. Quantification of risk factors for postherpetic neuralgia in herpes zoster patients: a cohort study. Neurology. 2016;87(1):94–102.CrossRefGoogle Scholar
  22. 22.
    Drolet M, Brisson M, Schmader K, Levin M, Johnson R, Oxman M, et al. Predictors of postherpetic neuralgia among patients with herpes zoster: a prospective study. J Pain. 2010;11(11):1211–21.CrossRefGoogle Scholar
  23. 23.
    Drolet M, Brisson M, Schmader KE, Levin MJ, Johnson R, Oxman MN, et al. The impact of herpes zoster and postherpetic neuralgia on health-related quality of life: a prospective study. CMAJ. 2010;182(16):1731–6.CrossRefGoogle Scholar
  24. 24.
    Singhal PK, Makin C, Pellissier J, Sy L, White R, Saddier P. Work and productivity loss related to herpes zoster. J Med Econ. 2011;14(5):639–45.CrossRefGoogle Scholar
  25. 25.
    Holbech JV, Bach FW, Finnerup NB, Jensen TS, Sindrup SH. Pain phenotype as a predictor for drug response in painful polyneuropathy-a retrospective analysis of data from controlled clinical trials. Pain. 2016;157(6):1305–13.CrossRefGoogle Scholar
  26. 26.
    Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352(22):2271–84.CrossRefGoogle Scholar
  27. 27.
    Lal H, Cunningham AL, Godeaux O, Chlibek R, Diez-Domingo J, Hwang SJ, et al. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med. 2015;372(22):2087–96.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Faculty of Health SciencesUniversity of BristolBristolUK

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