FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 352:2271-2284 June 2, 2005 Number 22 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Perspective by Arvin, A. Editorial by Gilden, D. H. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background The incidence and severity of herpes zoster and postherpetic neuralgia increase with age in association with a progressive decline in cell-mediated immunity to varicella–zoster virus (VZV). We tested the hypothesis that vaccination against VZV would decrease the incidence, severity, or both of herpes zoster and postherpetic neuralgia among older adults.

Methods We enrolled 38,546 adults 60 years of age or older in a randomized, double-blind, placebo-controlled trial of an investigational live attenuated Oka/Merck VZV vaccine ("zoster vaccine"). Herpes zoster was diagnosed according to clinical and laboratory criteria. The pain and discomfort associated with herpes zoster were measured repeatedly for six months. The primary end point was the burden of illness due to herpes zoster, a measure affected by the incidence, severity, and duration of the associated pain and discomfort. The secondary end point was the incidence of postherpetic neuralgia.

Results More than 95 percent of the subjects continued in the study to its completion, with a median of 3.12 years of surveillance for herpes zoster. A total of 957 confirmed cases of herpes zoster (315 among vaccine recipients and 642 among placebo recipients) and 107 cases of postherpetic neuralgia (27 among vaccine recipients and 80 among placebo recipients) were included in the efficacy analysis. The use of the zoster vaccine reduced the burden of illness due to herpes zoster by 61.1 percent (P<0.001), reduced the incidence of postherpetic neuralgia by 66.5 percent (P<0.001), and reduced the incidence of herpes zoster by 51.3 percent (P<0.001). Reactions at the injection site were more frequent among vaccine recipients but were generally mild.

Conclusions The zoster vaccine markedly reduced morbidity from herpes zoster and postherpetic neuralgia among older adults.

Source Information

The authors' affiliations are listed in the Appendix.

Address reprint requests to Dr. Oxman at the Shingles Prevention Study (Mail code 111F-1), VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, or at mnoxman{at}ucsd.edu.

Full Text of this Article

Related Letters:

A Vaccine to Prevent Herpes Zoster
Kessler K. M., Carroll I., Gaeta R., Mackey S., Oxman M. N., Levin M. J., Johnson G. R., the Shingles Prevention Study Group , Tsai A. G., Gilden D. H.
Extract | Full Text | PDF  
N Engl J Med 2005; 353:1414-1415, Sep 29, 2005. Correspondence

This article has been cited by other articles:

• Whitley, R. J. (2009). A 70-Year-Old Woman With Shingles: Review of Herpes Zoster. JAMA 302: 73-80 [Abstract] [Full Text]  
• SINGH, A., ENGLUND, K. (2009). IN REPLY:. Cleveland Clinic Journal of Medicine 76: 330-330 [Full Text]  
• Sutradhar, S. C., Wang, W. W. B., Schlienger, K., Stek, J. E., Xu, J., Chan, I. S. F., Silber, J. L. (2009). Comparison of the Levels of Immunogenicity and Safety of Zostavax in Adults 50 to 59 Years Old and in Adults 60 Years Old or Older. CVI 16: 646-652 [Abstract] [Full Text]  
• Gates, I. V., Zhang, Y., Shambaugh, C., Bauman, M. A., Tan, C., Bodmer, J.-L. (2009). Quantitative Measurement of Varicella-Zoster Virus Infection by Semiautomated Flow Cytometry. Appl. Environ. Microbiol. 75: 2027-2036 [Abstract] [Full Text]  
• Holmes, M. V., Atabani, S. F, Khan, N., Steiner, K., Haque, T., Slapak, G. (2009). A case for varicella vaccination in the immunosuppressed. BMJ Case Reports 2009: bcr0720080461-bcr0720080461 [Abstract] [Full Text]  
• Chia, J. K, Chia, A. A (2009). Varicella-zoster virus reactivation during acute enterovirus infection is associated with CD8 lymphocytopenia. BMJ Case Reports 2009: bcr0820080803-bcr0820080803 [Abstract] [Full Text]  
• Sampathkumar, P., Drage, L. A., Martin, D. P. (2009). Herpes Zoster (Shingles) and Postherpetic Neuralgia. Mayo Clin Proc. 84: 274-280 [Abstract] [Full Text]  
• Strangfeld, A., Listing, J., Herzer, P., Liebhaber, A., Rockwitz, K., Richter, C., Zink, A. (2009). Risk of Herpes Zoster in Patients With Rheumatoid Arthritis Treated With Anti-TNF-{alpha} Agents. JAMA 301: 737-744 [Abstract] [Full Text]  
• Whitley, R. J., Gnann, J. W. Jr (2009). Herpes Zoster in the Age of Focused Immunosuppressive Therapy. JAMA 301: 774-775 [Full Text]  
• Fuks, L., Shitrit, D., Fox, B. D., Amital, A., Raviv, Y., Bakal, I., Kramer, M. R. (2009). Herpes zoster after lung transplantation: incidence, timing, and outcome.. Ann. Thorac. Surg. 87: 423-426 [Abstract] [Full Text]  
• SINGH, A., ENGLUND, K. (2009). Q: Who should receive the shingles vaccine?. Cleveland Clinic Journal of Medicine 76: 45-48 [Full Text]  
• Cho, H. J., Lavretsky, H., Olmstead, R., Levin, M. J., Oxman, M. N., Irwin, M. R. (2008). Sleep Disturbance and Depression Recurrence in Community-Dwelling Older Adults: A Prospective Study. Am. J. Psychiatry 165: 1543-1550 [Abstract] [Full Text]  
• Brittle, E. E., Wang, F., Lubinski, J. M., Bunte, R. M., Friedman, H. M. (2008). A Replication-Competent, Neuronal Spread-Defective, Live Attenuated Herpes Simplex Virus Type 1 Vaccine. J. Virol. 82: 8431-8441 [Abstract] [Full Text]  
• Higashimoto, Y., Ihira, M., Ohta, A., Inoue, S., Usui, C., Asano, Y., Yoshikawa, T. (2008). Discriminating between Varicella-Zoster Virus Vaccine and Wild-Type Strains by Loop-Mediated Isothermal Amplification. J. Clin. Microbiol. 46: 2665-2670 [Abstract] [Full Text]  
• Stacy, S., Pasquali, A., Sexton, V. L., Cantwell, A. M., Kraig, E., Dube, P. H. (2008). An Age-Old Paradigm Challenged: Old Baboons Generate Vigorous Humoral Immune Responses to LcrV, A Plague Antigen. J. Immunol. 181: 109-115 [Abstract] [Full Text]  
• Hicks, L. D., Cook-Norris, R. H., Mendoza, N., Madkan, V., Arora, A., Tyring, S. K. (2008). Family History as a Risk Factor for Herpes Zoster: A Case-Control Study. Arch Dermatol 144: 603-608 [Abstract] [Full Text]  
• Opstelten, W., Eekhof, J., Neven, A. K., Verheij, T. (2008). Treatment of herpes zoster. cfp 54: 373-377 [Abstract] [Full Text]  
• Ward, T. M., Traina-Dorge, V., Davis, K. A., Gray, W. L. (2008). Recombinant simian varicella viruses expressing respiratory syncytial virus antigens are immunogenic. J. Gen. Virol. 89: 741-750 [Abstract] [Full Text]  
• Weikert, B. C., Blumberg, E. A. (2008). Viral Infection after Renal Transplantation: Surveillance and Management. CJASN 3: S76-S86 [Abstract] [Full Text]  
• Gilderman, L. I., Lawless, J. F., Nolen, T. M., Sterling, T., Rutledge, R. Z., Fernsler, D. A., Azrolan, N., Sutradhar, S. C., Wang, W. W., Chan, I. S. F., Schlienger, K., Schodel, F., Silber, J. L., for the Zostavax Protocol 010 Study Group, (2008). A Double-Blind, Randomized, Controlled, Multicenter Safety and Immunogenicity Study of a Refrigerator-Stable Formulation of Zostavax. CVI 15: 314-319 [Abstract] [Full Text]  
• Gershon, A. A. (2008). Varicella-Zoster Virus Infections. Pediatr. Rev. 29: 5-11 [Full Text]  
• Moss, S. M. (2007). Emerging vaccines: Evidence and considerations for practice integration. cfp 53: 2150-2156 [Full Text]  
• Curtis, K. K., Vikram, H. R. (2007). 66-Year-Old Man With Inarticulate Speech. Mayo Clin Proc. 82: 1562-1565 [Full Text]  
• Roderick, M., Ramanan, A. V, Finn, A. (2007). Should the UK introduce varicella vaccine?. Arch. Dis. Child. 92: 1051-1052 [Full Text]  
• Roush, S. W., Murphy, T. V., and the Vaccine-Preventable Disease Table Working, (2007). Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States. JAMA 298: 2155-2163 [Abstract] [Full Text]  
• Galluzzi, K. E. (2007). Managing Neuropathic Pain. JAOA: Journal of the American Osteopathic Association 107: ES39-ES48 [Abstract] [Full Text]  
• Yawn, B. P., Saddier, P., Wollan, P. C., Sauver, J. L. St., Kurland, M. J., Sy, L. S. (2007). A Population-Based Study of the Incidence and Complication Rates of Herpes Zoster Before Zoster Vaccine Introduction. Mayo Clin Proc. 82: 1341-1349 [Abstract] [Full Text]  
• Poland, G. A., Schaffner, W. (2007). Adult Immunization Guidelines: A Patient Safety and Quality-of-Care Issue. ANN INTERN MED 0: 0000605-200711200-00188-E-80 [Full Text]  
• Erard, V., Guthrie, K. A., Varley, C., Heugel, J., Wald, A., Flowers, M. E. D., Corey, L., Boeckh, M. (2007). One-year acyclovir prophylaxis for preventing varicella-zoster virus disease after hematopoietic cell transplantation: no evidence of rebound varicella-zoster virus disease after drug discontinuation. Blood 110: 3071-3077 [Abstract] [Full Text]  
• Zerboni, L., Reichelt, M., Jones, C. D., Zehnder, J. L., Ito, H., Arvin, A. M. (2007). From the Cover: Aberrant infection and persistence of varicella-zoster virus in human dorsal root ganglia in vivo in the absence of glycoprotein I. Proc. Natl. Acad. Sci. USA 104: 14086-14091 [Abstract] [Full Text]  
• Woo, E. J., Ball, R., Braun, M. M., Good, C. B., Keller, D. L., Lang, P.-O., Herrmann, F., Michel, J.-P., Senanayake, S. N. (2007). Varicella-Zoster Vaccine. NEJM 357: 88-90 [Full Text]  
• Committee on Infectious Diseases, (2007). Prevention of Varicella: Recommendations for Use of Varicella Vaccines in Children, Including a Recommendation for a Routine 2-Dose Varicella Immunization Schedule. Pediatrics 120: 221-231 [Abstract] [Full Text]  
• Wareham, D. W, Breuer, J. (2007). Herpes zoster. BMJ 334: 1211-1215 [Full Text]  
• Schott, G. D. (2007). Pain past, present and future: the unhappy paradox of scientific advances and therapeutic standstill. Brain 130: 1704-1708 [Full Text]  
• Kimberlin, D. W., Whitley, R. J. (2007). Varicella-Zoster Vaccine for the Prevention of Herpes Zoster. NEJM 356: 1338-1343 [Full Text]  
• Norberg, P., Liljeqvist, J.-A., Bergstrom, T., Sammons, S., Schmid, D. S., Loparev, V. N. (2006). Complete-Genome Phylogenetic Approach to Varicella-Zoster Virus Evolution: Genetic Divergence and Evidence for Recombination. J. Virol. 80: 9569-9576 [Abstract] [Full Text]  
• Hornberger, J., Robertus, K. (2006). Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.. ANN INTERN MED 145: 317-325 [Abstract] [Full Text]  
• Koplan, J. P., Harpaz, R. (2006). Shingles vaccine: effective and costly or cost-effective?. ANN INTERN MED 145: 386-387 [Full Text]  
• Goldman, G. S. (2006). The Case against Universal Varicella Vaccination. International Journal of Toxicology 25: 313-317 [Abstract] [Full Text]  
• Gilron, I., Watson, C. P. N., Cahill, C. M., Moulin, D. E. (2006). Neuropathic pain: a practical guide for the clinician.. CMAJ 175: 265-275 [Abstract] [Full Text]  
• Gregoire, S M, van Pesch, V, Goffette, S, Peeters, A, Sindic, C J M (2006). Polymerase chain reaction analysis and oligoclonal antibody in the cerebrospinal fluid from 34 patients with varicella-zoster virus infection of the nervous system. J. Neurol. Neurosurg. Psychiatry 77: 938-942 [Abstract] [Full Text]  
• Knight, C. L., Fihn, S. D. (2006). Update in General Internal Medicine. ANN INTERN MED 145: 52-61 [Full Text]  
• (2006). Zostavax: A New Vaccine to Reduce the Risk for Herpes Zoster in Older Adults. JWatch Infect. Diseases 2006: 12-12 [Full Text]  
• Gary, L., Gilden, D. H., Cohrs, R. J. (2006). Epigenetic regulation of varicella-zoster virus open reading frames 62 and 63 in latently infected human trigeminal Ganglia.. J. Virol. 80: 4921-4926 [Abstract] [Full Text]  
• Cohrs, R. J., Gilden, D. H., Gomi, Y., Yamanishi, K., Cohen, J. I. (2006). Comparison of Virus Transcription during Lytic Infection of the Oka Parental and Vaccine Strains of Varicella-Zoster Virus. J. Virol. 80: 2076-2082 [Abstract] [Full Text]  
• Fekete, T. (2005). A varicella-zoster virus vaccine reduced the burden of illness of herpes zoster in older adults. Evid. Based Med. 10: 177-177 [Full Text]  
• (2005). A Vaccine Against Herpes Zoster in Older People. JWatch Neurology 2005: 5-5 [Full Text]  
• Poland, G. A. (2005). The Growing Paradigm of Preventing Disease: Vaccines To Prevent Herpes Zoster and Pertussis in Adults. ANN INTERN MED 143: 539-541 [Full Text]  
• Kessler, K. M., Carroll, I., Gaeta, R., Mackey, S., Oxman, M. N., Levin, M. J., Johnson, G. R., the Shingles Prevention Study Group, , Tsai, A. G., Gilden, D. H. (2005). A vaccine to prevent herpes zoster.. NEJM 353: 1414-1415 [Full Text]  
• (2005). Herpes zoster vaccine is safe and effective for older adults. BMJ 331: - [Full Text]  
• Galluzzi, K. E. (2005). Management of Neuropathic Pain. JAOA: Journal of the American Osteopathic Association 105: S12-S19 [Abstract] [Full Text]  
• Tenser, R. B., Dworkin, R. H. (2005). Herpes zoster and the prevention of postherpetic neuralgia: Beyond antiviral therapy. Neurology 65: 349-350 [Full Text]  
• Weir, E. (2005). Vaccination boosts adult immunity to varicella zoster virus. CMAJ 173: 249-249 [Full Text]  
• (2005). A Vaccine to Prevent Herpes Zoster in Elders. JWatch Women's Health 2005: 6-6 [Full Text]  
• (2005). A Vaccine to Prevent Shingles. JWatch Gastroenterology 2005: 10-10 [Full Text]  
• (2005). Varicella Vaccine Reduces Herpes Zoster Morbidity in Older Adults. JWatch Infect. Diseases 2005: 1-1 [Full Text]  
• (2005). Vaccinating the Elderly to Prevent Shingles. Journal Watch Dermatology 2005: 5-5 [Full Text]  
• (2005). A Vaccine to Prevent Shingles. JWatch General 2005: 2-2 [Full Text]  
• Martyn, C. (2005). What's new in the other general journals. BMJ 330: 1351-1351 [Full Text]  
• Gilden, D. H. (2005). Varicella-Zoster Virus Vaccine -- Grown-ups Need It, Too. NEJM 352: 2344-2346 [Full Text]