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Wednesday 20 May 2015
Adjuvanted HZ/su vaccine in older adults

"Efficacy of an Adjuvanted Herpes Zoster Subunit Vaccine in Older Adults", a new important study published at the end of April on the New England Journal of Medicine.

Summary of the article

Herpes zoster, or shingles, results from the reactivation of latent varicella–zoster virus (VZV) in the dorsal-root or cranial-nerve ganglia, usually decades after primary infection. Although herpes zoster is most frequent in adults who are 50 years of age or older owing to immunosenescence, it can occur at any age, especially when cell-mediated immunity is decreased as a result of disease or drug therapy.

Common complications, such as postherpetic neuralgia, are more frequent and severe with increasing age.

A live-attenuated vaccine against herpes zoster (Zostavax, Merck) containing the Oka VZV strain is licensed for use in adults who are 50 years of age or older. Zostavax showed 51.3% efficacy against herpes zoster and 66.5% efficacy against postherpetic neuralgia in participants who were 60 years of age or older. However, its efficacy against herpes zoster decreased with age.

Recombinant subunit vaccines are an alternative to live-attenuated vaccines and may also be suitable for persons with immunosuppression because the risk of disease resulting from replication of the vaccine virus is prevented. An investigational recombinant subunit vaccine containing VZV glycoprotein E and the AS01B adjuvant system (called HZ/su, GlaxoSmithKline Biologicals) is being evaluated for the prevention of herpes zoster in older adults. VZV glycoprotein E was selected as a candidate vaccine antigen.

This study was a randomized, placebo-controlled, phase 3 study in 18 countries to evaluate the efficacy and safety of HZ/su in older adults (≥50 years of age), stratified according to age group (50 to 59, 60 to 69, and ≥70 years). Participants received two intramuscular doses of the vaccine or placebo 2 months apart. The primary objective was to assess the efficacy of the vaccine, as compared with placebo, in reducing the risk of herpes zoster in older adults.

The HZ/su vaccine significantly reduced the risk of herpes zoster in adults who were 50 years of age or older. Vaccine efficacy in adults who were 70 years of age or older was similar to that in the other two age groups.

Authors: Himal Lal, Anthony L. Cunningham, Olivier Godeaux, Roman Chlibek, Javier Diez-Domingo, Shinn-Jang Hwang, Myron J. Levin, Janet E. McElhaney, Airi Poder, Joan Puig-Barberà, Timo Vesikari, Daisuke Watanabe, Lily Weckx, Toufik Zahaf, and Thomas C. Heineman

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