Healthy Ageing: Herpes Zoster Infection and the Role of Zoster Vaccination

Overview

Journal NPJ Vaccines

Date 2023 Nov 28

PMID 38017011

Authors

Desmond Curran

T Mark Doherty

Nicolas Lecrenier

Thomas Breuer

Affiliations

Soon will be listed here.

Abstract

Populations are ageing worldwide, with considerable time lived in ill-health, putting upwards pressure on healthcare budgets. Healthy ageing is defined as maintaining functional ability, including the ability to: meet basic needs; learn, grow and make decisions; be mobile; build and maintain relationships; and contribute to society. The risk and impact of infectious diseases increase with age due to immunosenescence. Vaccination can help to prevent disease in older adults, promoting healthy ageing and active lives. Herpes zoster (HZ) occurs when the varicella zoster virus is reactivated due to declining immunity. HZ is common, with a lifetime risk of one-third, and increases in incidence with age. HZ is associated with severe and intense pain, substantially affecting the functional status of patients as well as their overall health-related quality of life. HZ and its complications may result in prolonged morbidity, including persistent pain (post-herpetic neuralgia, PHN), hearing impairment, vision loss and increased risk of stroke and myocardial infarction. HZ and PHN are difficult to treat, substantiating the benefits of prevention. Vaccines to prevent HZ include a recombinant zoster vaccine (RZV). RZV has shown efficacy against the HZ burden of disease and HZ burden of interference on activities of daily living of over 90% in immunocompetent adults aged ≥50 years. Vaccine efficacy against HZ was maintained at over 70% at 10 years post-vaccination. Adult vaccination, including against HZ, has the potential to reduce burden of disease, thus helping to maintain functioning and quality of life to support healthy ageing in older adults.

Citing Articles

Patient preferences toward herpes zoster vaccination among individuals aged 50 years or older in South Korea: Findings from a discrete choice experiment.

Shantakumar S, Choo E, Parikh R, Kwon T, Kim H, Vandervoort L Hum Vaccin Immunother. 2025; 21(1):2469419.

PMID: 40063054 PMC: 11901505. DOI: 10.1080/21645515.2025.2469419.

Temporary spinal cord stimulation combined with lidocaine patch for postherpetic neuralgia in the elderly: a controlled study.

Li Y, Hao C, Wang S, Qiu F, Zhao X, Sun T Front Neurol. 2025; 16:1529673.

PMID: 39944544 PMC: 11816358. DOI: 10.3389/fneur.2025.1529673.

Abnormal Alterations of the White Matter Structural Network in Patients with Herpes Zoster and Postherpetic Neuralgia.

Li Z, Gu L, Jiang X, Liu J, Li J, Xie Y Brain Topogr. 2025; 38(2):28.

PMID: 39912964 DOI: 10.1007/s10548-025-01104-3.

Abnormal alterations in structure-function coupling at the modular level in patients with postherpetic neuralgia.

Li Z, Jiang J, Jiang X, Xie Y, Lu J, Gu L Sci Rep. 2025; 15(1):2377.

PMID: 39827190 PMC: 11742715. DOI: 10.1038/s41598-025-86908-w.

The Herpes Zoster Patient Pathway and Gaps in Current Vaccination Guidelines in Southeast Asia: Summary of a Zoster Experts' Network Scientific Workshop.

Bibera G, San Martin P, van Oorschot D, Hidayati A, Permatasari D, Ponnampalavanar S Vaccines (Basel). 2025; 12(12.

PMID: 39772093 PMC: 11728494. DOI: 10.3390/vaccines12121433.

References

Cunningham A, Lal H, Kovac M, Chlibek R, Hwang S, Diez-Domingo J . Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older. N Engl J Med. 2016; 375(11):1019-32. DOI: 10.1056/NEJMoa1603800. View

Lal H, Poder A, Campora L, Geeraerts B, Oostvogels L, Abeele C . Immunogenicity, reactogenicity and safety of 2 doses of an adjuvanted herpes zoster subunit vaccine administered 2, 6 or 12 months apart in older adults: Results of a phase III, randomized, open-label, multicenter study. Vaccine. 2017; 36(1):148-154. DOI: 10.1016/j.vaccine.2017.11.019. View

Oostvogels L, Heineman T, Johnson R, Levin M, McElhaney J, van den Steen P . Medical conditions at enrollment do not impact efficacy and safety of the adjuvanted recombinant zoster vaccine: a pooled post-hoc analysis of two parallel randomized trials. Hum Vaccin Immunother. 2019; 15(12):2865-2872. PMC: 6930113. DOI: 10.1080/21645515.2019.1627818. View

Dagnew A, Ilhan O, Lee W, Woszczyk D, Kwak J, Bowcock S . Immunogenicity and safety of the adjuvanted recombinant zoster vaccine in adults with haematological malignancies: a phase 3, randomised, clinical trial and post-hoc efficacy analysis. Lancet Infect Dis. 2019; 19(9):988-1000. DOI: 10.1016/S1473-3099(19)30163-X. View

Lal H, Cunningham A, Godeaux O, Chlibek R, Diez-Domingo J, Hwang S . Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med. 2015; 372(22):2087-96. DOI: 10.1056/NEJMoa1501184. View

Weinberger B . Vaccination of older adults: Influenza, pneumococcal disease, herpes zoster, COVID-19 and beyond. Immun Ageing. 2021; 18(1):38. PMC: 8501352. DOI: 10.1186/s12979-021-00249-6. View

Zerboni L, Hinchliffe S, Sommer M, Ito H, Besser J, Stamatis S . Analysis of varicella zoster virus attenuation by evaluation of chimeric parent Oka/vaccine Oka recombinant viruses in skin xenografts in the SCIDhu mouse model. Virology. 2005; 332(1):337-46. DOI: 10.1016/j.virol.2004.10.047. View

Kim J, Johnson R, Kovac M, Cunningham A, Amakrane M, Sullivan K . Adjuvanted recombinant zoster vaccine decreases herpes zoster-associated pain and the use of pain medication across 3 randomized, placebo-controlled trials. Pain. 2022; 164(4):741-748. PMC: 10026829. DOI: 10.1097/j.pain.0000000000002760. View

Chevalier-Cottin E, Ashbaugh H, Brooke N, Gavazzi G, Santillana M, Burlet N . Communicating Benefits from Vaccines Beyond Preventing Infectious Diseases. Infect Dis Ther. 2020; 9(3):467-480. PMC: 7452969. DOI: 10.1007/s40121-020-00312-7. View

10.

Schmader K, Sloane R, Pieper C, Coplan P, Nikas A, Saddier P . The impact of acute herpes zoster pain and discomfort on functional status and quality of life in older adults. Clin J Pain. 2007; 23(6):490-6. DOI: 10.1097/AJP.0b013e318065b6c9. View

11.

Lopez-Fauqued M, Campora L, Delannois F, El Idrissi M, Oostvogels L, De Looze F . Safety profile of the adjuvanted recombinant zoster vaccine: Pooled analysis of two large randomised phase 3 trials. Vaccine. 2019; 37(18):2482-2493. DOI: 10.1016/j.vaccine.2019.03.043. View

12.

Lecrenier N, Beukelaers P, Colindres R, Curran D, De Kesel C, De Saegher J . Development of adjuvanted recombinant zoster vaccine and its implications for shingles prevention. Expert Rev Vaccines. 2018; 17(7):619-634. DOI: 10.1080/14760584.2018.1495565. View

13.

Yang W, Kandula S, Huynh M, Greene S, Van Wye G, Li W . Estimating the infection-fatality risk of SARS-CoV-2 in New York City during the spring 2020 pandemic wave: a model-based analysis. Lancet Infect Dis. 2020; 21(2):203-212. PMC: 7572090. DOI: 10.1016/S1473-3099(20)30769-6. View

14.

Matthews S, Curran D, Cabrera E, Boutry C, Lecrenier N, Cunningham A . An Analysis of How Herpes Zoster Pain Affects Health-related Quality of Life of Placebo Patients From 3 Randomized Phase III Studies. Clin J Pain. 2023; 39(8):386-393. PMC: 10353534. DOI: 10.1097/AJP.0000000000001129. View

15.

Giannelos N, Ng C, Curran D . Cost-effectiveness of the recombinant zoster vaccine (RZV) against herpes zoster: An updated critical review. Hum Vaccin Immunother. 2023; 19(1):2168952. PMC: 10054181. DOI: 10.1080/21645515.2023.2168952. View

16.

Curran D, Kim J, Matthews S, Dessart C, Levin M, Oostvogels L . Recombinant Zoster Vaccine Is Efficacious and Safe in Frail Individuals. J Am Geriatr Soc. 2020; 69(3):744-752. PMC: 7984267. DOI: 10.1111/jgs.16917. View

17.

Diez-Domingo J, Curran D, Cambronero M, Garcia-Martinez J, Matthews S . Economic Burden and Impact on Quality of Life of Herpes Zoster in Spanish Adults Aged 50 Years or Older: A Prospective Cohort Study. Adv Ther. 2021; 38(6):3325-3341. PMC: 8190024. DOI: 10.1007/s12325-021-01717-7. View

18.

Anderson T, Masters N, Guo A, Shepersky L, Leidner A, Lee G . Use of Recombinant Zoster Vaccine in Immunocompromised Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep. 2022; 71(3):80-84. PMC: 8774159. DOI: 10.15585/mmwr.mm7103a2. View

19.

Laupeze B, Del Giudice G, Doherty M, van der Most R . Vaccination as a preventative measure contributing to immune fitness. NPJ Vaccines. 2021; 6(1):93. PMC: 8316335. DOI: 10.1038/s41541-021-00354-z. View

20.

Curran D, Van Oorschot D, Matthews S, Hain J, Salem A, Schwarz M . Long-term efficacy data for the recombinant zoster vaccine: impact on public health and cost effectiveness in Germany. Hum Vaccin Immunother. 2021; 17(12):5296-5303. PMC: 8904019. DOI: 10.1080/21645515.2021.2002085. View