Herpes zoster vaccination efficacy in the long-term care facility population: a qualitative systematic review

Abstract

Background: The varicella zoster virus (VZV) can reactivate later in life as herpes zoster infection (HZI), a severe disease resulting in painful complications such as post-herpetic neuralgia (PHN). The herpes zoster (HZ) vaccine has been indicated for use among adults 50 years and older for prevention of HZI. Currently, no clinical practice guideline or funding exists specifically for HZ immunization in long-term care facilities (LTCF) for adults age >60 years.

Objectives: This review summarizes the current literature available on the efficacy of HZ vaccine in adults over 60 years old residing in LTCF and evaluates the cost-effectiveness of the HZ vaccine.

Methods: We conducted a literature search in PsycInFO, Embase and MEDLINE databases, and a grey literature search. The search was limited to the last 5 years (January 2013–April 2018). Studies that assessed the efficacy of the HZ vaccine in individuals 60 years old or older and met inclusion criteria were included.

Results: A total of 423 studies were found: 10 studies met inclusion criteria and were deemed relevant to the objectives. All reviewed studies highlighted the efficacy of the HZ vaccine for the LTCF population.

Conclusions: The studies reviewed showed the efficacy of the HZ vaccine in relevant elderly populations residing either in LTCF or in the community including those of advanced age with multiple comorbidities. Consideration can be given to the use of the HZ vaccine for individuals over 60 in LTCF, as well as in the community.

Keywords:

• Herpes zoster vaccine
• varicella zoster vaccine
• nursing home
• long term care
• elderly
• aged

Notes

Transparency

Declaration of funding

This manuscript received no funding.

Author contributions

H.S.: conception and design of the study, acquisition of data, interpretation of data, drafting and revision of the article, final approval of the submitted version of the manuscript. J.G.: acquisition of data, interpretation of data, drafting and revision of the manuscript. MM: acquisition of data, interpretation of data, drafting and revision of the manuscript.

Declaration of financial/other relationships

No potential conflict of interest was reported by the authors. A CMRO peer reviewer has disclosed that, whilst an employee of GlaxoSmithKline, they did significant work on the herpes zoster vaccine Shingrix (a competitor of Zostavax) and are an author on almost all phase 3 studies on Shingrix. CMRO peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Acknowledgements

We would like to acknowledge Samuel Belmont (BMSc candidate class of 2019, Western University) for his efforts in literature search, data collection, manuscript editing and overall contributions in preparation of this manuscript.

Notes

1 Zostavax (Zoster Vaccine, Live) is a registered trade mark of Merck & Co., Inc, New Jersey, NJ, USA.

2 Shingrix (Zoster Vaccine Recombinant, Adjuvanted) is a registered trade mark of GlaxoSmithKline biologicals, USA.