Vaccines for preventing herpes zoster in older adults

• Published in: Cochrane database of systematic reviews 2019-11, Vol.2019 (11)
• Main Authors: Gagliardi, Anna Mz, Andriolo, Brenda Ng, Torloni, Maria Regina, Soares, Bernardo Go, de Oliveira Gomes, Juliana, Andriolo, Regis B, Canteiro Cruz, Eduardo
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antiviral Agents - therapeutic use; Herpes Zoster - prevention & control; Herpes Zoster Vaccine - therapeutic use; Herpesvirus 3, Human; Humans; Infectious disease; Middle Aged; Randomized Controlled Trials as Topic; Shingles (herpes zoster); Vaccination; Vaccines, Attenuated - therapeutic use
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD008858.pub4

Herpes zoster, commonly known as shingles, is a neurocutaneous disease caused by the reactivation of the virus that causes varicella (chickenpox). After resolution of the varicella episode, the virus can remain latent in the sensitive dorsal ganglia of the spine. Years later, with declining immunity, the varicella zoster virus (VZV) can reactivate and cause herpes zoster, an extremely painful condition that can last many weeks or months and significantly compromise the quality of life of the affected person. The natural process of aging is associated with a reduction in cellular immunity, and this predisposes older people to herpes zoster. Vaccination with an attenuated form of the VZV activates specific T-cell production avoiding viral reactivation. The USA Food and Drug Administration has approved a herpes zoster vaccine with an attenuated active virus, live zoster vaccine (LZV), for clinical use amongst older adults, which has been tested in large populations. A new adjuvanted recombinant VZV subunit zoster vaccine, recombinant zoster vaccine (RZV), has also been approved. It consists of recombinant VZV glycoprotein E and a liposome-based AS01B adjuvant system. This is an update of a Cochrane Review last updated in 2016. To evaluate the effectiveness and safety of vaccination for preventing herpes zoster in older adults. For this 2019 update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1, January 2019), MEDLINE (1948 to January 2019), Embase (2010 to January 2019), CINAHL (1981 to January 2019), LILACS (1982 to January 2019), WHO ICTRP (on 31 January 2019) and ClinicalTrials.gov (on 31 January 2019). We included randomised controlled trials (RCTs) or quasi-RCTs comparing zoster vaccine (any dose and potency) versus any other type of intervention (e.g. varicella vaccine, antiviral medication), placebo, or no intervention (no vaccine). Outcomes were incidence of herpes zoster, adverse events (death, serious adverse events, systemic reactions, or local reaction occurring at any time after vaccination), and dropouts. We used standard methodological procedures expected by Cochrane. We included 11 new studies involving 18,615 participants in this update. The review now includes a total of 24 studies involving 88,531 participants. Only three studies assessed the incidence of herpes zoster in groups that received vaccines versus placebo. Most studies were conducted in high-income countries in Europe and North America and inclu