Shingles vaccine is associated with reduction in both postherpetic neuralgia and herpes zoster, but uptake in the US is low
A vaccine to prevent shingles may reduce by half the occurrence of this painful skin and nerve infection in older people (aged over 65 years) and may also reduce the rate of a painful complication of shingles, post-herpetic neuralgia, but has a very low uptake (only 4%) in older adults in the United States, according to a study by UK and US researchers published in this week's PLOS Medicine.
The researchers, led by Sinéad Langan from the London School of Hygiene and Tropical Medicine, reached these conclusions by examining the records of 766,330 Medicare beneficiaries* aged 65 years or more between 2007 and 2009.
They found that shingles vaccine uptake was extremely low—only 3.9% of participants were vaccinated—but was particularly low among black people (0.3%) and among people with a low income (0.6%).
Over the study period, almost 13,000 participants developed shingles and the vaccine reduced the rate of shingles by 48% (that is, approximately half as many vaccinated individuals developed shingles as those who were not vaccinated). However, the vaccine was less effective in older adults with impaired immune systems. The authors also found that vaccine effectiveness against post-herpetic neuralgia was 59%.
The authors say: "Herpes zoster vaccination was associated with a significant reduction in incident herpes zoster and [post-herpetic neuralgia] in routine clinical use."
They continue: "Despite strong evidence supporting its effectiveness, clinical use remains disappointingly low with particularly low vaccination rates in particular patient groups."
The authors add: " The findings are relevant beyond US medical practice, being of major importance to the many countries, including the UK, that are actively considering introducing the zoster vaccine into routine practice in the near future."
* Medicare is a US government health insurance scheme that mainly helps to pay the health-care costs of people aged 65 or older.
Funding: This research was funded by an NIHR Clinician Scientist award from the National Institute for Health Research, UK Department of Health, awarded to SML. The funders of the study had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the UK Department of Health.
Competing Interests: LS has undertaken consultancy for GlaxoSmithKline. DJM is on separate data safety monitoring boards for Abbott and Astellas. The authors declare no other conflicts of interest.
Citation: Langan SM, Smeeth L, Margolis DJ, Thomas SL (2013) Herpes Zoster Vaccine Effectiveness against Incident Herpes Zoster and Post-herpetic Neuralgia in an Older US Population: A Cohort Study. PLoS Med 10(4): e1001420. doi:10.1371/journal.pmed.1001420
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