Recombinant Zoster Vaccine Works Well in Older Patients

By Abigail Zuger, MD

Dr. Zuger is an associate editor with NEJM Journal Watch General Medicine, from which this story was adapted. Full coverage is available to subscribers at the link below.

A new two-dose recombinant zoster vaccine was 90% efficacious among adults older than 70 in an industry-supported, randomized trial published in the New England Journal of Medicine. The subunit vaccine contains recombinant varicella zoster virus glycoprotein E with a potent adjuvant.

The vaccine or placebo was administered to nearly 11,000 immunocompetent adults aged 70 to 79 and about 3000 aged 80 or older. After mean follow up of 3.7 years, zoster incidences were 9.2 and 0.9 per 1000 person-years in placebo and vaccine recipients, respectively. There was no diminution of vaccine efficacy among those 80 or older. Overall postherpetic neuralgia rates were lower in vaccine recipients, only because of the lower risk for zoster.

About 75% of vaccine recipients reported local reactions, most mild to moderate, and about half of recipients reported mild systemic reactions (e.g., fatigue).

Comment: This study suggests that the long-awaited recombinant zoster vaccine — which is not yet FDA-approved — offers some advantages to older patients, compared with the live attenuated vaccine. Editorialists note the high rates of local and systemic reactions and wonder if patients might be reluctant to accept the second dose during routine use. We also await information on the vaccine’s safety and efficacy in sicker and immunocompromised adults.