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Efficacy of Herpes Zoster Vaccine in Older Adults

N Engl J Med; 2016 Sep 15; Cunningham, et al

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The risks of herpes zoster and postherpetic neuralgia were reduced among adults aged ≥70 years after administration of the herpes zoster subunit vaccine (HZ/su), a recent study found. The randomized, placebo-controlled phase 3 trial was conducted in 18 countries with participants receiving 2 doses of HZ/su or placebo administered intramuscularly 2 months apart. Vaccine efficacy against herpes zoster and postherpetic neuralgia was assessed in participants from the trial of adults aged ≥70 years (ZOE-70) and in participants pooled from ZOE-70 and the trial of adults aged ≥50 years (ZOE-50). Researchers found:

• 13,900 participants in ZOE-70 (mean age, 75.6 years) received either HZ/su (n=6,950) or placebo (n=6,950).

• Herpes zoster occurred in 23 HZ/su patients and in 223 placebo participants during a mean follow-up period of 3.7 years.

• Vaccine efficacy against herpes zoster was 89.8% and similar in participants aged 70 to 79 years (90.0%) and those aged ≥80 years (89.1%).

• Vaccine efficacy against herpes zoster in from participants aged ≥70 years in ZOE-50 and ZOE-70 (n=16,596) was 91.3%; and against postherpetic neuralgia was 88.8%.

• Frequency of serious adverse events were similar in the 2 study groups.

Citation: Cunningham AL, Lal H, Kovac M, et al. Efficacy of the herpes zoster subunit vaccine in adults 70 years of age and older. N Engl J Med. 2016;375:1019-32. doi:10.1056/NEJMoa1603800.

Commentary: This herpes zoster subunit vaccine (HZ/su) shows important improvements in efficacy compared to the currently licensed Zoster vaccine. The current live attenuated vaccine (Zostavax) has efficacy that declines with age: 70% in adults 50 to 59 years of age, 64% in adults 60 to 69 years of age, 41% in adults 70 to 79 years of age, and 18% in adults 80 years of age or older.1 It has additional efficacy in protecting against the development of post-herpes neuralgia, though that efficacy also wanes with age.2 This herpes zoster subunit vaccine, with efficacy above 90% in all age groups, represents an exciting advance in protection against herpes zoster. —Neil Skolnik, MD

1. Leroux-Roels I, Leroux-Roels G, Clement F, et al. A phase 1/2 clinical trial evaluating safety and immunogenicity of a varicella zoster glycoprotein E subunit vaccine candidate in young and older adults. J Infect Dis. 2012;206:1280-90.

2. Chlibek R, Smetana J, Pauksens K, et al. Safety and immunogenicity of three different formulations of an adjuvanted varicella-zoster virus subunit candidate vaccine in older adults: a phase II, randomized, controlled study. Vaccine. 2014;32:1745-53.

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