Authors: Whitley RJ., Clin Infect Dis 2015 Mar 15; 60:910
This is for our providers that take care of chronic pain patients.
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.”
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.
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