Zoster Vaccine: Current Status and Future Prospects

Michael N. Oxman () 0 1 0 Received 13 October 2009; accepted 6 April 2010; electronically published 15 June 2010. The observations and conclusions in this review are those of the author and do not necessarily reflect the views of his colleagues or the Department of Veterans Affairs. VA Medical Center , 3350 La Jolla Village Dr, San Diego, CA 92161 1 Infectious Diseases Section, Department of Veterans Affairs San Diego Healthcare System, and Division of Infectious Diseases, University of California , San Diego Live, attenuated Oka/Merck varicella-zoster virus (VZV) vaccine (zoster vaccine) protects immunocompetent adults from herpes zoster and its complications. Success of zoster vaccine in preventing the clinical manifestations of latent VZV reactivation contrasts with the failure to achieve similar results with vaccination to prevent recurrent herpes simplex. This reflects major differences in the pathophysiology of latency and reactivation of these 2 alphaherpesviruses. The Shingles Prevention Study and many others have demonstrated that VZV-specific cell-mediated immunity, but not VZV antibody, plays a critical role in limiting reactivation and replication of latent VZV and, thus, in preventing herpes zoster and its complications. Consequently, induction of VZV-specific cell-mediated immunity and not antibody should be used as a proxy for the clinical efficacy of new formulations and uses of zoster vaccine. Prospects for improved zoster vaccines and their use in immunocompromised patients are discussed, and questions related to zoster vaccine use are addressed. - BACKGROUND Characteristic History Properties Varicella vaccine Zoster vaccine Zoster vaccine safety and efficacy Recent developments Description References [3032] [24, 3340] [4162] [18, 63] [18, 19, 6366] (Merck, personal communication) [62, 6778] LABORATORY CORRELATES OF CLINICAL EFFICACY Zoster vaccine Placebo Definition of PHN by duration of pain after HZ rash onset No. of confirmed cases of HZ with PHN Incidence of PHN per 1000 person-yearsa No. of confirmed cases of HZ with PHN Incidence of PHN per 1000 person-yearsa 130 days 160 days 190 days 1120 days 1182 days 1.39 0.77 0.46 0.29 0.16 3.39 1.96 1.38 0.93 0.57 Zoster vaccine efficacy, % (95% CI) 58.9 (46.668.7) 60.4 (43.672.6) 66.5 (47.579.2) 68.7 (45.283.0) 72.9 (42.188.6) FUTURE DIRECTIONS Acknowledgments References (...truncated)