Assessment of the potential public health impact of Herpes Zoster vaccination in Germany

Figures & data

Figure 1. Cases avoided with HZ/su vs. No Vaccination and ZVL vs. No Vaccination by Age Cohort: (A) HZ Cases, (B) PHN Cases, (C) Complications HZ/su: herpes zoster subunit; ZVL: Zoster Vaccine Live; HZ: herpes zoster; PHN: postherpetic neuralgia; No Vacc: No Vaccination; yoa: years of age.

Table 1. Public Health impact of both HZ/su and ZVL under base case assumptions of 40% coverage (HZ/su second dose compliance of 70%) over a lifetime horizon from the age of vaccination.

	Cases	Cases Avoided*
	No Vaccination	HZ/su	ZVL
Subjects	35,495,639	14,198,256	14,198,256
HZ	9,216,271	1,745,179	499,117
PHN	1,717,545	309,795	117,828
Complications	1,128,993	213,784	61,141
Deaths	3,683	361	32
Hospitalisation	524,602	85,652	19,472
GP Visits	52,169,013	9,388,338	2,478,437

yoa: years of age; HZ: herpes zoster; PHN: postherpetic neuralgia; GP: General Practitioner; HZ/su: herpes zoster subunit; ZVL: Zoster Vaccine Live

*In Vaccinated Subjects compared with no vaccination over the life-time of the respective cohorts

Figure 2. HZ cases avoided with HZ/su vs. No Vaccination and ZVL vs. No Vaccination from the Year of Vaccination by Age Cohort. HZ: herpes zoster; HZ/su: herpes zoster subunit; ZVL: Zoster Vaccine Live. Note incidence is included as an age-specific step function (see Table 4) and this explains the step increases over time, particularly pronounced in the 50–59 y old age group.

Table 2. Public health impact scenario analysis assuming a coverage of 40% over a lifetime horizon from the age of vaccination (HZ/su second dose compliance of 50% and 90%).

	Cases Avoided*
	HZ/su : 50% second dose	HZ/su : 90% second dose
Subjects	14,198,256	14,198,256
HZ	1,498,578	1,991,780
PHN	264,082	355,510
Complications	183,576	243,993
Deaths	293	430
Hospitalisation	72,276	99,031
GP Visits	8,008,476	10,768,200

yoa: years of age; HZ: herpes zoster; PHN: postherpetic neuralgia; GP: General Practitioner; HZ/su: herpes zoster subunit.

*In Vaccinated Subjects over the life-time of the respective cohorts

Table 3. Number needed to vaccinate to prevent one HZ case and one PHN case.

	HZ/su Second dose compliance
	50%	70%	90%	ZVL
NNV for HZ
50–59 yoa	9	8	7	27
60–69 yoa	9	8	7	20
70+ yoa	13	11	10	50
NNV for PHN
50–59 yoa	56	46	39	198
60–69 yoa	45	39	35	106
70+ yoa	62	53	47	94

yoa: years of age; HZ: herpes zoster; PHN: postherpetic neuralgia; HZ/su: herpes zoster subunit; NNV: Number needed to vaccinate. Note estimated NNV values were rounded up to the nearest integer.

Figure 3. Tornado Diagram: HZ cases avoided with HZ/su compared with ZVL HZ/su: herpes zoster subunit; HZ: herpes zoster. The ranges used for the DSA are detailed in the Table S1.

Figure 4. Probabilistic Sensitivity Analysis: HZ cases avoided with HZ/su compared with ZVL (5,000 simulations). HZ/su: herpes zoster subunit; HZ: herpes zoster. The ranges used for the PSA are detailed in the Table S1.

Figure 5. Schematic overview of Markov structure – ZONA model. HZ: herpes zoster; PHN: postherpetic neuralgia.

Table 4. Base Case Epidemiological inputs.

Age Groups	Incidence (per 1,000)^Citation33	PHN*^Citation33	HZ Mortality Rates*^Citation10	Hospitalization*^Citation10	Number of Physician Visits**^Citation38
50–59 yoa	7.75	13.0%	0.001%	0.023%	4.13
60–64 yoa	10.02	15.4%	0.003%	0.034%	4.94
65–69 yoa	11.44	17.5%	0.005%	0.041%	4.97
70–74 yoa	13.43	19.9%	0.010%	0.057%	5.92
75–79 yoa			0.025%
80–84 yoa	13.90	20.4%	0.043%	0.081%	6.36
85+ yoa			0.165%

yoa: years of age; HZ: Herpes Zoster; PHN: postherpetic neuralgia,

* % of HZ cases,

** Mean number of visits per HZ cases

Table 5. Vaccine efficacy against HZ and PHN.

	Age groups	HZ Efficacy (%)	PHN Efficacy (%)
ZVL ZEST Study^Citation15
	50–59 yoa	69.80	NE
ZVL SPS Study^Citation14
	60–69 yoa	63.89	65.69
	70–79 yoa	40.85	73.38
	80+ yoa	18.25	39.51
ZOE-50 HZ/su 2-dose^17
	Overall 50+ yoa	97.16	100
	50–59 yoa	96.57	NE
	60–69 yoa	97.36	NE
	70+ yoa	97.93	NE
ZOE-70+ HZ/su 2-dose^18
	70+ yoa	91.30	88.8
	70–79 yoa	91.27	NE
	80+ yoa	91.37	NE
ZOE-50 HZ/su 1-dose
	50+ yoa	90.09	NE
ZOE-70+ HZ/su 1-dose
	70+ yoa	69.51	NE

yoa: years of age; HZ: herpes zoster; PHN: postherpetic neuralgia; HZ/su: herpes zoster subunit; NE: not estimated; ZVL: Zoster Vaccine Live; SPS: Shingles Prevention Study; ZEST: Zoster Efficacy and Safety Study

^$ : Data on file

Figure 6. HZ efficacy waning over time. HZ: herpes zoster; SPS: Shingles Prevention Study; LTPS: Long Term Persistence Study.

Figure 7. Focus on the Patient.

Hillebrand K , Bricout H , Schulze-Rath R , Schink T , Garbe E . Incidence of herpes zoster and its complications in Germany, 2005-2009. J Infect 2015; 70:178-86; PMID:25230396; https://doi.org/10.1016/j.jinf.2014.08.018

 PubMed Web of Science ®Google Scholar

Ultsch B , Siedler A , Rieck T , Reinhold T , Krause G , Wichmann O . Herpes zoster in Germany: Quantifying the burden of disease. BMC Infect Dis 2011; 11:173; PMID:21679419; https://doi.org/10.1186/1471-2334-11-173

 PubMed Web of Science ®Google Scholar

Schiffner-Rohe J , Köster L , Beillat M , Lilie HM , Schubert I . Resource consumption and health care costs of Herpes zoster and postherpetic neuralgia in Germany (article in German). Gesundheitsökonomie & Qualitätsmanagement 2011; 16:216-23; https://doi.org/10.1055/s-0029-1245896

 Google Scholar

Schmader KE , Levin MJ , Gnann JW Jr , McNeil SA , Vesikari T , Betts RF , Keay S , Stek JE , Bundick ND , Su SC , et al. Efficacy, safety, and tolerability of herpes zoster vaccine in persons aged 50-59 years. Clin Infect Dis 2012; 54:922-8; PMID:22291101; https://doi.org/10.1093/cid/cir970

 PubMed Web of Science ®Google Scholar

Oxman MN , Levin MJ , Johnson GR , Schmader KE , Straus SE , Gelb LD , Arbeit RD , Simberkoff MS , Gershon AA , Davis LE , et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005; 352:2271-84; PMID:15930418; https://doi.org/10.1056/NEJMoa051016

 PubMed Web of Science ®Google Scholar