Presented by: Michael Oxman, for the Shingles Prevention Study Group. VA San Diego Healthcare System and the University of California, San Diego, CA, USA.

The incidence and severity of herpes zoster and postherpetic neuralgia (PHN) increase with age in association with a progressive decline in cell-mediated immunity (CMI) to varicella zoster virus (VZV). The Shingles Prevention Study was designed to test the hypothesis that vaccinating older persons with a highpotency VZV vaccine would boost their waning CMI to VZV, thereby protecting them from herpes zoster and PHN. An immunology substudy was conducted to evaluate immune responses to the vaccine and the possible relationship of those responses to the risk of herpes zoster and PHN. Zoster vaccine reduced the burden of illness due to herpes zoster by 61.1% (P<0.001), the incidence of PHN by 66.5% (P<0.001) and the incidence of herpes zoster by 51.3% (P<0.001). The zoster vaccine was well tolerated, and it neither caused nor induced herpes zoster.¹

Results of immunological assays at baseline confirmed a progressive loss of VZV-CMI with increasing age (P<0.001), and no significant age-related change in titers of antibody to VZV (P=0.48). VZV immune responses in vaccine recipients were significantly increased over baseline (P<0.001) and compared to responses in placebo recipients at 6 weeks after vaccination, and significant increases were sustained at 1, 2 and 3 years. VZV-CMI responses in the vaccine group were greater in subjects 60–69 years of age than in those ³70 (P<0.01). These age-related differences in VZV-CMI were paralleled by age-related differences in the incidence and severity of herpes zoster, and in the clinical efficacy of the zoster vaccine.

Reference

1.    Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD et al. N Engl J Med 2005;352:2271–2284.

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