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Herpes zoster vaccine for older adults?


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.

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Authors

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