Zoster vaccine shows benefit in reducing postherpetic neuralgia

  • Bruxvoort KJ & al.
  • Vaccine
  • 11 May 2019

  • International Clinical Digest
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Takeaway

  • Zoster vaccine live (ZVL) reduces herpes zoster (HZ)-associated postherpetic neuralgia (PHN) pain duration and severity in both sexes, even when HZ occurs despite vaccination.

Why this matters

  • Include education about severe PHN pain prevention when encouraging uptake of HZ vaccine.
  • Ensure patients know that even if ZVL does not offer 100% protection against developing HZ, it might improve overall outcomes.

Key results

  • 1018 PCR-confirmed patients with HZ (509, 509; ZVL vaccinated, unvaccinated, respectively).
  • 68.6% patients ≥70 years at diagnosis, 62.8% (639) women.
  • At baseline, risk for worst pain ≥3 (75.4% vs 78.7%), ≥7 pain points (40.9% vs 46.5%), vaccinated vs unvaccinated, respectively.
  • From 30 to 60 to 90 days, percentage reporting pain continued to decline:
    • Day 90: risk for worst pain ≥3 reported by 9.2% vs 15.4%, vaccinated vs unvaccinated, respectively (adjusted relative risk [aRR], 0.594; 95% CI, 0.413-0.854).
    • Risk for worst pain ≥7 reported by 2.0% vs 4.8%, vaccinated vs unvaccinated, respectively (aRR, 0.332; 95% CI, 0.153-0.721).
  • PHN risk increased with age (4.6% vs 11.1%, vaccinated vs unvaccinated, respectively).

Study design

  • Prospective cohort analysis of ZVL vaccinated, unvaccinated patients with laboratory-confirmed HZ to assess HZ-related pain progression, ZVL effect on PHN.
  • Funding: NIH.

Limitations

  • Participation bias.
  • Minimal nonresponse bias.
  • Low subgroup sample sizes.