Zoster vaccine seen as a useful tool for reducing burden of illness

Systematic vaccination against chickenpox has had dramatic benefits for reducing the costs and burden of varicella zoster virus (VZV) disease. However, experts are anticipating that its widespread use may also result in an increase of herpes zoster (HZ), herpes zoster ophthalmicus (HZO), and postherpetic neuralgia (PHN) in the general population.

“Thus, the more efficient is vaccination against VZV, the more we need vaccination against HZ,” said Marc Labetoulle, MD, at the 5th EuCornea Congress.

 Dr. Labetoulle, professor of ophthalmology, University of Paris Sud, Paris, France, explained that VZV-specific cell-mediated immunity, which is an important mechanism in preventing reactivation of latent VZV as HZ, is boosted by periodic re-exposure to VZV. A decrease in the numbers of young people with active chickenpox in the general population would limit this restimulation and thereby may change the classical epidemiology of HZ.

Noting that systematic vaccination against chickenpox began in the United States in 1995, Dr. Labetoulle said it will soon be seen if the prediction about increasing HZ/HZO risk is true. Emphasising the debilitating nature of the disease and its complications, he advocated the importance of the preventive vaccine. Available data support the cost-effectiveness of the VZV vaccine (Zostavax) for reducing the burden of VZV-related disease, Dr. Labetoulle said. 

According to one study, the number needed to treat to avoid one PHN event is a reasonably low 55, and another analysis from France estimated a cost-effective ratio of up to ~12,000 Euros per quality-adjusted life year gained, corresponding to gains of ~2500 Euros per HZ case avoided and of ~ 4000 Euros per PHN case avoided.

Dr. Labetoulle stated there is a lot of discussion in Europe about the indications for the vaccine and reimbursement. Whereas in North America the VZV vaccine is recommended for adults ≥60 years, the proposed indications in France are for administration to adults ages 65 to 74 years old.

Currently, it is recommended that the vaccine not be given to persons who are immunocompromised.

However, new information suggests this policy should be reconsidered.