Vaccines for preventing herpes zoster in older adults

Ana M. Z. Gagliardi; Bernardo Garcia De Oliveira Soares; Brenda Nazaré Gomes Silva; Maria Regina Torloni

摘要

BACKGROUND:Herpes zoster or, as it is commonly called, 'shingles' is a neurocutaneous disease characterised by the reactivation of varicella zoster virus (VZV), the virus that causes chickenpox, which is latent in the dorsal spinal ganglia when immunity to VZV declines. It is an extremely painful condition which can often last for many weeks or months, impairing the patient's quality of life. The natural aging process is associated with a reduction of cellular immunity which predisposes to herpes zoster. Vaccination with an attenuated form of VZV activates specific T cell production, therefore avoiding viral reactivation. A herpes zoster vaccine with an active virus has been approved for clinical use among older adults by the Food and Drug Administration and has been tested in large populations.OBJECTIVE:To evaluate the effectiveness and safety of vaccination for preventing herpes zoster in older adults.METHODSSearch methods: We searched the following sources for relevant studies: CENTRAL 2012, Issue 7, MEDLINE (1948 to July week 1, 2012), EMBASE (2010 to July 2012), LILACS (1982 to July 2012) and CINAHL (1981 to July 2012). We also reviewed reference lists of identified trials and reviews for additional studies.Selection criteria: Randomised controlled trials (RCTs) or quasi-RCTs comparing zoster vaccine with placebo or no vaccine, to prevent herpes zoster in older adults (mean age 60 years).Data collection and analysis: Two review authors independently collected and analysed data using a data extraction form. They also carried out an assessment of risk of bias.MAIN RESULTS:We identified eight RCTs with a total of 52,269 participants. Three studies were classified at low risk of bias. The main outcomes on effectiveness and safety were extracted from one clinical trial with a low risk of bias. Four studies compared zoster vaccine versus placebo; one study compared high-potency zoster vaccine versus low-potency zoster vaccine; one study compared refrigerated zoster vaccine versus frozen zoster vaccine; one study compared live zoster vaccine versus inactivated zoster vaccine and one study compared zoster vaccine versus pneumococcal polysaccharide vaccine (pneumo 23).Confirmed cases of herpes zoster were less frequent in patients who received the vaccine than in those who received a placebo: risk ratio (RR) 0.49 (95% confidence interval (CI) 0.43 to 0.56), with a risk difference (RD) of 2%, and number needed to treat to benefit (NNTB) of 50. Analyses according to age groups indicated a greater benefit in participants aged 60 to 69 years, RR 0.36 (95% CI 0.30 to 0.45) and in participants aged 70 years and over, RR 0.63 (95% CI 0.53 to 0.75). Vaccine-related systemic adverse effects were more frequent in the vaccinated group (RR 1.29, 95% CI 1.05 to 1.57, number needed to treat to harm (NNTH) = 100). The pooled data risk ratio for adverse effects for participants with one or more inoculation site adverse effect was RR 4.51 (95% CI 2.35 to 8.68), and the NNTH was 2.8 (95% CI 2.3 to 3.4). Side effects were more frequent in younger (60 to 69 years) than in older (70 years and over) participants.AUTHORS' CONCLUSIONS:Herpes zoster vaccine is effective in preventing herpes zoster disease. Although vaccine benefits are larger in the younger age group (60 to 69 years), this is also the age group with more adverse events. In general, zoster vaccine is well tolerated; it produces few systemic adverse events and injection site adverse effects of mild to moderate intensity.

机译：背景：带状疱疹或通常称为“带状疱疹”是一种神经皮肤疾病，其特征在于水痘带状疱疹病毒（VZV）的重新激活，该病毒可引起水痘，当对VZV的免疫力下降时，它会潜伏在脊髓背神经节中。这是一种极度痛苦的状况，通常会持续数周或数月，损害患者的生活质量。自然的衰老过程与细胞免疫力的降低有关，后者倾向于带状疱疹。减毒形式的VZV疫苗接种可激活特异性T细胞的产生，因此避免了病毒的再激活。美国食品药品监督管理局（FDA）已批准将具有活性病毒的带状疱疹疫苗用于老年人临床使用，并已在大量人群中进行了测试。目的：评估预防老年人带状疱疹疫苗接种的有效性和安全性。方法：我们从以下来源进行了相关研究：中心2012年，第7期，MEDLINE（1948年至2012年7月1日），EMBASE（2010年至2012年7月），LILACS（1982年至2012年7月）和CINAHL（1981年至2012年7月））。我们还审查了已鉴定试验的参考文献清单并进行了进一步研究。选择标准：比较带状疱疹疫苗与安慰剂或无疫苗的随机对照试验（RCT）或准RCT，以预防老年人（平均年龄> 60岁）带状疱疹数据收集和分析：两位评论作者使用数据提取表独立收集和分析数据。他们还进行了偏倚风险评估。主要结果：我们确定了8个RCT，共有52,269名参与者。三项研究被归类为偏倚风险低。有效性和安全性的主要结果来自一项偏倚风险低的临床试验。四项研究比较了带状疱疹疫苗与安慰剂;一项研究比较了强效带状疱疹疫苗和低效带状疱疹疫苗。一项研究比较了冷冻带状疫苗与冷冻带状疫苗。一项研究比较了带状疱疹活疫苗和灭活的带状疱疹疫苗，还有一项研究比较了带状疱疹疫苗和肺炎球菌多糖疫苗（第23肺炎）。确认接种疫苗的患者中带状疱疹的发病率低于接受安慰剂的患者：风险比（ RR）0.49（95％置信区间（CI）0.43至0.56），风险差异（RD）为2％，需要治疗的受益人数（NNTB）为50。按年龄段进行的分析表明，在60至69岁的参与者，RR为0.36（95％CI为0.30至0.45），70岁及以上的参与者为RR 0.63（95％CI为0.53至0.75）。疫苗接种组中与疫苗相关的全身性不良反应更为常见（RR 1.29，95％CI 1.05至1.57，治疗伤害所需的数字（NNTH）= 100）。对于具有一种或多种接种部位不良反应的参与者，不良反应汇总数据风险比为RR 4.51（95％CI 2.35至8.68），而NNTH为2.8（95％CI 2.3至3.4）。与年龄较大（70岁及以上）的参与者相比，年龄较小（60至69岁）的副作用更为频繁。作者的结论：带状疱疹疫苗可有效预防带状疱疹疾病。尽管在年龄较小的年龄段（60至69岁）中疫苗受益更大，但该年龄段的不良事件也更多。通常，带状疱疹疫苗耐受性良好。它几乎不产生全身性不良事件，对轻度至中度强度的注射部位也没有不良影响。

Vaccines for preventing herpes zoster in older adults

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