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Herpes Zoster Vaccines

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Book cover Herpes Zoster: Postherpetic Neuralgia and Other Complications

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Abstract

Herpes zoster is a localized disease of the sensory ganglion, nerve and skin, caused by reactivation and replication of endogenous varicella-zoster virus (VZV) that has persisted as a latent infection in sensory and autonomic neurons following an earlier episode of varicella. It is characterized by unilateral radicular pain and a vesicular rash that is generally limited to the dermatome innervated by a single spinal or cranial sensory ganglion. Replication and spread of reactivated VZV within the sensory ganglion and adjacent neural structures causes necrosis of neurons and supporting cells, resulting in neuropathic pain and sensory dysfunction in the affected dermatome during the acute phase of herpes zoster.Neuropathic pain may persist after rash healing, a debilitating complication known as postherpetic neuralgia (PHN). The incidence and severity of herpes zoster and PHN increase markedly with increasing age in parallel with an age-related decline in VZV-specific cell mediated immunity (VZV CMI).Antiviral treatment can reduce the duration and severity of acute herpes zoster and prevent complications that result from continued VZV replication and spread, but it does not prevent the development of PHN.

The Shingles Prevention Study (SPS) demonstrated that a live attenuated zoster vaccine reduced the burden of illness due to herpes zoster by 61 %, the incidence of PHN by 67 %, and the incidence of herpes zoster by 51 % in persons ≥60 years of age. Vaccine efficacy for the incidence of PHN was undiminished in older (≥70 year-old) subjects compared to those who were 60-69 years of age.Large retrospective effectiveness studies have confirmed the SPS results.Zoster vaccine efficacy waned over time in the SPS subjects, and long-term effectiveness studies have also confirmed this observation.A newly-developed adjuvanted VZV glycoprotein E vaccine shows significantly greater efficacy and can be administered to immunocompromised patients in whom the use of live attenuated zoster vaccine is contraindicated.

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Acknowledgments

MNO and RH are grateful to Ms. Donna Mussatto for her expertise and patience in preparing the manuscript and to the James M. and Jesse V. Scott Fund for Shingles Research for continued support. We also thank Dr. Mona Marin for her kind help in clarifying the details of her recent studies.

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Authors and Affiliations

  1. Department of Medicine, Division of Infectious Diseases, University of California San Diego, La Jolla, California, USA

    Michael N. Oxman

  2. Medicine Service, Infectious Diseases Section, VA San Diego Healthcare System, San Diego, California, USA

    Michael N. Oxman

  3. Department of Medicine, Division of Infectious Diseases, University of California San Diego, La Jolla, California, USA

    Ruth Harbecke

  4. Research Service, VA San Diego Healthcare System, San Diego, California, USA

    Ruth Harbecke

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  1. Michael N. Oxman
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  2. Ruth Harbecke
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Correspondence to Michael N. Oxman .

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  1. Department of Medicine, University of Toronto Department of Medicine, TORONTO, Ontario, Canada

    C. Peter N. Watson

  2. College of Physicians & Surgeons, Columbia University College of Physicians & Surgeons, New York, New York, USA

    Anne A. Gershon

  3. Department of Medicine, Division of Infectious Diseases, University of California, San Diego, La Jolla, California, USA

    Michael N. Oxman

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Oxman, M.N., Harbecke, R. (2017). Herpes Zoster Vaccines. In: Watson, C., Gershon, A., Oxman, M. (eds) Herpes Zoster: Postherpetic Neuralgia and Other Complications. Adis, Cham. https://doi.org/10.1007/978-3-319-44348-5_24

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