March 5, 2015Abigail Zuger, MD reviewing Morrison VA et al. Clin Infect Dis 2015 Mar 15. Whitley RJ. Clin Infect Dis 2015 Mar 15.After 10 years, vaccination lost most of its power.Short-term follow-up of participants in placebo-controlled studies of the herpes zoster (HZ) vaccine confirmed that the vaccine was efficacious for at least 5 years (NEJM JW Gen Med Dec 1 2012 and Clin Infect Dis 2012; 55:1320). Now, long-term follow-up of some original vaccine recipients, including placebo-group members who were vaccinated when the studies were completed, has allowed investigators to estimate longer-term efficacy.
Almost 7000 vaccine recipients (median age, 74) were monitored for about 4 years after the original studies ended, most through year 10 after vaccination; of 347 suspected cases of HZ in this cohort, 263 were confirmed. Historical controls were used to assess several measures of vaccine efficacy.
Efficacy against HZ incidence fell from 46% in year 7 to 14% in year 10 and was negligible among the 1470 participants who were followed for an 11th year. Efficacies against postherpetic neuralgia and against a composite “burden of illness” score also were negligible by year 11. Overall estimates of vaccine efficacy between 5 and 12 years after vaccination were 21% against HZ incidence, 35% against postherpetic neuralgia, and 37% against “burden of illness.”
COMMENT
These numbers suggest that
a single dose of herpes zoster vaccine administered at age 60 is unlikely to confer protection for the duration of a person's life. The authors caution that absence of a true placebo group precludes drawing any firm conclusions from this study's data. However,
an editorialist cautiously suggests “rethinking public health recommendations” and possibly endorsing a second dose of vaccine about 8 years after the first.EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Abigail Zuger, MD at time of publication
Editorial boardsNew York Times; Clinical Infectious Diseases
CITATION(S):
Morrison VA et al. Long-term persistence of zoster vaccine efficacy. Clin Infect Dis 2015 Mar 15; 60:900. (Δεν είναι ορατοί οι σύνδεσμοι (links).
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Whitley RJ.Waning efficacy of the herpes zoster vaccine. Clin Infect Dis 2015 Mar 15; 60:910. (Δεν είναι ορατοί οι σύνδεσμοι (links).
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