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Herpes zoster vaccine for older adults?

Anton J.F.A. Kerst, Leo M.L. Stolk
Nr 9|2020 (54)|Page 97-101|New|doi: 10.35351/gebu.2020.9.16

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The Dutch National health Care Institute recommends including the new recombinant herpes zoster vaccine Shingrix® in the government’s national vaccination programme for adults aged 60 years, to prevent postherpetic neuralgia. This implies that the Council is of the opinion that the balance between efficacy and adverse effects of the vaccine is favourable for the elderly. The reservation made by the Council is that the vaccine must be cost-effective. Since this is not the case at the price used in the cost-effectiveness calculation, however, large-scale Shingrix vaccination of older adults is not yet considered advisable. There has been limited research into the use of this vaccine in immunocompromised patients, who might benefit most from it. 
  • A small proportion  of patients with herpes zoster suffer from prolonged or even permanent postherpetic neuralgia.
  • The Dutch National health Care Institute has recommended including herpes zoster vaccination for persons aged 60 year in the national vaccination programme. Prevention by means of this vaccination programme would, however, be a drastic and costly intervention for this limited clinical problem.
  • Applying the vaccine for immunocompromised patients, who might benefit most from it, seems suitable, although research into the vaccine for this group has as yet been limited.
  • The EMA’s Committee for Medicinal Products for Human Use has very recently published a ‘positive opinion’ on extending the indication for the vaccine to the group of adults older than 18 years who are at elevated risk of herpes zoster. At the time of publication of this article, this had not yet been included in the authorisation text.
  1. Gezondheidsraad. Vaccinatie tegen Gordelroos. Advies aan de staatssecretaris van Volksgezondheid, Welzijn en Sport. Den Haag: Gezondheidsraad, 15 juli 2019. Publicatienr. 2019/12
  2. van Wijck AJM, Aerssens YR. Pain, Itch, Quality of Life, and Costs after Herpes Zoster. Pain Pract. 2017;17(6):738-746. doi:10.1111/papr.12518
  3. Cunningham AL, Lal H, Kovac M, et al. Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older. N Engl J Med. 2016;375(11):1019-1032. doi:10.1056/NEJMoa1603800
  4. Lal H, Cunningham AL, Godeaux O, et al. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med. 2015;372(22):2087-2096. doi:10.1056/NEJMoa1501184
  5. CHMP Summary of opinion (post-authorisation) Shingrix. 23 July 2020. Via: www.ema.europa.eu/en/medicines/human/summaries-opinion/shingrix. Geraadpleegd op 07-08-2020
  6. Kerst AJ. Number Needed to Treat (NNT). Gebu. 2001;35(10):117-118
  7. Demicheli V, Jefferson T, Ferroni E, Rivetti A, Di Pietrantonj C. Vaccines for preventing influenza in healthy adults. Cochrane Database Syst Rev. 2018;2(2):CD001269. Published 2018 Feb 1. doi:10.1002/14651858.CD001269.pub6 
  8. Dayan RR, Peleg R. Herpes zoster - typical and atypical presentations. Postgrad Med. 2017;129(6):567-571. doi:10.1080/00325481.2017.1335574
  9. Productinformatie Shingrix®. Via: www.ema.europa.eu/en/medicines/human/EPAR/shingrix. Geraadpleegd op 13-08-2020
  10. Garçon N, Di Pasquale A. From discovery to licensure, the Adjuvant System story. Hum Vaccin Immunother. 2017;13(1):19-33. doi:10.1080/21645515.2016.1225635
  11. G-Standaard handelsproducten. Via: KNMP Kennisbank. Geraadpleegd op 10-08-2020
  12. Productinformatie Zostavax®. Via www.ema.europa.eu/en/medicines/human/EPAR/zostavax. Geraadpleegd op 13-08-2020
  13. Productinformatie Provarivax®. Via: www.geneesmiddeleninformatiebank.nl. Geraadpleegd op 09-06-2020
  14. Wichers IM, Opstelten W. NHG-Behandelrichtlijn Gordelroos. Versie 1.0, januari 2019. Via: https://richtlijnen.nhg.org/behandelrichtlijnen/gordelroos#volledige-tekst. Geraadpleegd op 13-08-2020
  15. De Jong L, Janssen PGH, Keizer D, et al. NHG-Standaard Pijn. Versie 2.1, juni 2018. Via: https://richtlijnen.nhg.org/standaarden/pijn. Geraadpleegd op 05-06-2020
  16. Berkowitz EM, Moyle G, Stellbrink HJ, et al. Safety and immunogenicity of an adjuvanted herpes zoster subunit candidate vaccine in HIV-infected adults: a phase 1/2a randomized, placebo-controlled study. J Infect Dis. 2015;211(8):1279-1287. doi:10.1093/infdis/jiu606
  17. Stadtmauer EA, Sullivan KM, Marty FM, et al. A phase 1/2 study of an adjuvanted varicella-zoster virus subunit vaccine in autologous hematopoietic cell transplant recipients. Blood. 2014;124(19):2921-2929. doi:10.1182/blood-2014-04-573048
  18. de Boer PT, van Lier A, de Melker H, et al. Cost-effectiveness of vaccination of immunocompetent older adults against herpes zoster in the Netherlands: a comparison between the adjuvanted subunit and live-attenuated vaccines. BMC Med. 2018;16(1):228. Published 2018 Dec 6. doi:10.1186/s12916-018-1213-5

Authors

  • Anton J.F.A. Kerst, dr
  • Leo M.L. Stolk, dr