Herpes Zoster Virus Vaccine for the Prevention of Shingles

STEPS
New Drug Reviews
AFP vol 75 no 12

Safety

• no increased risk of varicella-like or zoster-like rashes after vaccine administration
• should not be used in patients who are immunosuppressed
• no instances of transmission from those with vaccines
• postpone if patient has an acute febrile illness (fever > 101.3; 38.5)

Tolerability

• 1/3 of patients will experience erythema, pain, tenderness at site
• no systemic reactions have been reported

Effectiveness

• decreases the occurence of zoster by 50%
• 3.3% of unvaccinated persons develop zoster compared to 1.6% of vaccinated
• vaccination prevents postherpetic neuralgia in 66% of persons receiving the vaccine (approximately 0.4% in unvaccinated versus 0.14% of vaccinated)
• 60 patients need to be treated to prevent one additional case of zoster over 3 years
• 360 patients need to be treated to prevent one additional case of neuralgia
• protection lasts at least 4 years; the absolute duration has yet to be determined.

Price

• ~$186
• patients covered by Medicare may submit the cost of vaccination for reimbursement via Medicare Part D

Bottom Line

• Herpes Zoster Vaccine decreases the incidence of shingles  and postherpetic neuralgia.
• It is an effective vaccine that should be offered to anyone who are 60 years of age or older