Shingles vaccine adminstration

INTRODUCTION:
Surprisingly, much of the general public do not know one of the human Herpesviruses, varicellazoster virus (VZV), causes chickenpox, and results in a life-long infection. VZV can re-activate after decades of being dormant in sensory nerve ganglia (usually in those over 60 years of age) to cause shingles infection. After being in development for nearly 30 years, a new vaccine was released in 2018 (Shingrix™) to protect against developing shingles. This report details how well the Shingrix™ vaccine works in protecting against shingles across gender, geographic regions, and ancestry.

DISCUSSION:
Shingles, also called Herpes zoster (HZ), affects 1 in 3 individuals during their lives. HZ’s primary complication is nerve pain called postherpetic neuralgia (PHN), which will occur in up to 30% of patients. The incidence of HZ increases with age and immunecompromising conditions, which include cancer, chronic pulmonary disease, rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, chronic kidney disease, HIV, diabetes, asthma, immunosuppression treatments, and even depression. Sunlight (UV) can also result in VZV reactivation, causing shingles. Since so many conditions lead to VZV reactivation, it is necessary to prevent HZ from occurring for quality of life reasons. Willer et al.1Willer, D. O., Oostvogels, L., Cunningham, A. L., Gervais, P., Gorfinkel, I., Kim, J. H., Talarico, C., Wascotte, V., Zahaf, T., Colindres, R., Schuind, A.(2019). Efficacy of the adjuvanted recombinant zoster vaccine (RZV) by sex, geographic region, and geographic ancestry/ethnicity: A post-hoc analysis of the ZOE-50 and ZOE-70 randomized trials. Vaccine, 37(43), 6262-6267. https://doi.org/10.1016/j.vaccine.2019.09.028 reported how well the adjuvanted recombinant zoster vaccine (RZV), known commercially as Shingrix™, prevents HZ. They reported, according to sex, geographic region, and geographic ancestry/ethnicity, the post-hoc analysis of vaccine efficacy against HZ for adults 50 years of age (YOA), and the pooled data from adults over 50 YOA plus adults over 70 YOA. Adults (mean age of 62.3) >50 YOA or >70 YOA were randomized 1:1 to receive two doses of either RZV (7340 people) or placebo (7413 people) 2 months apart. PCR confirmed suspected HZ cases. Geographic regions grouped the 18 participating countries. Efficacy against HZ was >90% in both female and male participants in the 50/70 populations. Efficacy against PHN was 91.5% and 83.3% in female and male participants, respectively. In the 50 YOA group, efficacy against HZ ranged from 95.7% for North America to 97.2% for Europe. In the pooled 50/70 group, HZ’s efficacy ranged from 87.3% for Latin America to 95.1% for Asia/Australia. In the pooled 50/70 group, efficacy against PHN was 90.8% in Asia/Australia, 86.8% in Europe, and 100% in North America. Concerning efficacy against HZ and PHN according to geographic ancestry/ethnicity, in the pooled 50/70 group, efficacy against HZ ranged from 89.6% to 100% in European and African geographic ancestry participants, respectively. In participants of Hispanic ethnicity, efficacy was 88.1%. Efficacy against PHN in the pooled 50/70 group was 87.5% and 89.8% in European and Asian ancestry participants, respectively. No PHN cases occurred in African ancestry participants and only a few PHN cases occurred in other ancestries or of Hispanic ethnicity.

CONCLUSION:
Willer et al.2Willer, D. O., Oostvogels, L., Cunningham, A. L., Gervais, P., Gorfinkel, I., Kim, J. H., Talarico, C., Wascotte, V., Zahaf, T., Colindres, R., Schuind, A.(2019). Efficacy of the adjuvanted recombinant zoster vaccine (RZV) by sex, geographic region, and geographic ancestry/ethnicity: A post-hoc analysis of the ZOE-50 and ZOE-70 randomized trials. Vaccine, 37(43), 6262-6267. https://doi.org/10.1016/j.vaccine.2019.09.028 post-hoc analysis confirmed the recombinant zoster vaccine, Shingrix™, is efficacious in preventing Herpes zoster and postherpetic neuralgia irrespective of sex, geographic region, and geographic ancestry/ethnicity. It is crucial that those who had chickenpox as a child be pro-active in preventing the possibility of getting shingles as they age and especially if they have any of the immune compromising medical conditions listed above.

By David Kilpatrick, PhD and Abbas Vafai, PhD

MKTG 1049 Rev A