Impact of Herpes Zoster Vaccine on Postherpetic Neuralgia: A Comprehensive Review

International Journal of Biomedicine 15(4) (2025) 649-652 http://dx.doi.org/10.21103/Article15(4)_RA5 MINI REVIEW INTERNATIONAL JOURNAL OF BIOMEDICINE Impact of Herpes Zoster Vaccine on Postherpetic Neuralgia: A Comprehensive Review Ramadan S. Hussein1*, Salman Bin Dayel1, Othman Abahussein1, Waled Kamal Abdelbasset2, Osama Mahfouz3 Department of Dermatology, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia 2 Department of Physical Therapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates 3 Department of Emergency, King Saud University medical city, Riyadh, Saudi Arabia 1 Abstract Background: Herpes zoster (HZ), also known as shingles, is often complicated by postherpetic neuralgia (PHN), a chronic pain condition that significantly impairs quality of life. Vaccination against HZ has become a key preventive strategy to lower the risk of PHN. This review evaluates the effectiveness of HZ vaccines in reducing the incidence of PHN. Methods and Results: In accordance with PRISMA guidelines, a systematic search was conducted across PubMed, Embase, Web of Science, and the Cochrane Library up to May 2024. Eligible studies included randomized controlled trials (RCTs), cohort studies, and observational studies that reported quantitative outcomes on the occurrence of PHN after vaccination. The included studies encompassed diverse populations, primarily older adults. The recombinant zoster vaccine (RZV) demonstrated a substantial reduction in PHN incidence, with effectiveness approaching 60%. In contrast, the live zoster vaccine (ZVL) showed notable early protection, though its efficacy declined over time. The recombinant zoster vaccine (RZV) was associated with higher rates of mild, self-limiting adverse reactions compared with ZVL. Conclusions: Both HZ vaccines, particularly RZV, are effective in preventing PHN and exhibit acceptable safety profiles. Broader vaccine uptake could decrease the public health burden of PHN. Long-term data on the duration of immunity and the potential role of booster doses remain areas for future investigation.(International Journal of Biomedicine. 2025;15(4):649-652.) Keywords: herpes zoster • neuralgia • vaccine For citation: Hussein RS, Dayel SB, Abahussein O, Abdelbasset WK, Mahfouz O. Impact of Herpes Zoster Vaccine on Postherpetic Neuralgia: A Comprehensive Review. International Journal of Biomedicine. 2025;15(4):649-652. doi:10.21103/ Article15(4)_RA5 Abbreviations HZ, herpes zoster; PHN, postherpetic neuralgia; RZV, recombinant zoster vaccine; RCTs, randomized controlled trials; VZV, varicella-zoster virus; ZVL, live zoster vaccine. Introduction Herpes zoster (HZ), also known as shingles, is caused by the reactivation of the latent varicella-zoster virus (VZV), the same virus responsible for causing chickenpox. Following primary infection, usually in childhood, VZV remains dormant within sensory ganglia and can reactivate later in life. Age-related immune decline, immunosuppression, and psychosocial stress are among the major triggers of viral reactivation, leading to the development of HZ. Clinically, HZ presents as a painful, vesicular rash in a dermatomal distribution, often preceded by prodromal symptoms such as itching, burning, or tingling sensations.1 The most common and burdensome complication of HZ is postherpetic neuralgia (PHN), a chronic neuropathic pain syndrome that may persist for months or years after rash resolution. PHN significantly impairs quality of life, contributing to ongoing pain, functional limitations, sleep 650 R. S. Hussein et al. / International Journal of Biomedicine 15(4) (2025) 649-652 disturbances, and psychological distress. Beyond individual suffering, PHN imposes a considerable healthcare and economic burden due to prolonged treatment needs and increased healthcare utilization.2,3 Because PHN is difficult to treat and often refractory to available therapies, prevention has become a major clinical priority. Vaccination against HZ has emerged as an effective strategy to reduce both the incidence and severity of HZ and, by extension, the risk of PHN. By enhancing VZV-specific immunity, vaccines aim to prevent reactivation or attenuate disease severity, thereby lowering the likelihood of PHN development.4,5 Current recommendations target older adults, the population at greatest risk, with evidence suggesting a meaningful reduction in HZ and its complications following vaccination.6 Nonetheless, questions remain regarding the degree of protection specifically against PHN, underscoring the need for a systematic evaluation of available evidence. In this review, we assess the impact of HZ vaccination on the incidence of PHN. By synthesizing data across clinical trials and observational studies, we aim to clarify the effectiveness of HZ vaccines in mitigating one of the most persistent and debilitating outcomes of HZ. Methods We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library for studies published up to May 2024, and screened reference lists of relevant articles. Eligible studies included randomized controlled trials, cohort, case-control studies, and observational studies that assessed herpes zoster (HZ) vaccination and reported quantitative data on postherpetic neuralgia (PHN) incidence in humans. Reviews, editorials, case reports, and studies without relevant outcomes were excluded. Search terms combined keywords and MeSH headings for “herpes zoster,” “shingles,” “postherpetic neuralgia,” and “vaccine.” Two reviewers independently screened records, extracted data, and resolved discrepancies by consensus. Extracted variables included study and participant characteristics, vaccine type and regimen, and outcomes (PHN incidence, follow-up duration, vaccine efficacy, and adverse events). The primary outcome was the incidence of PHN after vaccination; secondary outcomes included the incidence of HZ, vaccine efficacy, and safety. The methods followed the PRISMA guidelines. Results Across randomized trials, cohort, and observational studies, herpes zoster (HZ) vaccination consistently reduced postherpetic neuralgia (PHN) incidence. Most studies involved adults aged ≥50 years from the United States, New Zealand, and Southeast Asia, with sample sizes up to >30,000. The recombinant zoster vaccine (RZV) lowered PHN incidence by ~60% in older adults, with durable protection over several years. By contrast, live zoster vaccine (ZVL) showed strong early efficacy but declined markedly over time, suggesting a need for booster strategies.6-9 Recombinant zoster vaccine (RZV) was associated with higher rates of mild local and systemic reactions than ZVL, but serious adverse events were rare.10-13 Modeling studies predicted substantial public health gains: raising RZV coverage to 65% in Southeast Asia could prevent hundreds of thousands of PHN cases over 15 years, with significant healthcare cost savings.12,13 Subgroup (...truncated)