Vaccine profile of herpes zoster (HZ/su) subunit vaccine

ABSTRACT

Introduction: Herpes zoster (HZ) causes an often severe and painful rash in older people and may be complicated by prolonged pain (postherpetic neuralgia; PHN) and by dissemination in immune-compromised patients. HZ results from reactivation of latent varicella-zoster virus (VZV) infection, often associated with age-related or other causes of decreased T cell immunity. A live attenuated vaccine boosts this immunity and provides partial protection against HZ, but this decreases with age and declines over 8 years.

Areas covered: A new HZ subunit (HZ/su) vaccine combines a key surface VZV glycoprotein (E) with a T cell-boosting adjuvant system (AS01_B) and is administered by two intramuscular injections two months apart.

Expert commentary: HZ/su showed excellent efficacy of ~90% in immunocompetent adults ≥50 and ≥70 years of age, respectively, in the ZOE-50 and ZOE-70 phase III controlled trials. Efficacy was unaffected by advancing age and persisted for >3 years. Approximately 9.5% of subjects had severe, but transient (1–2 days) injection site pain, swelling or redness. Compliance with both vaccine doses was high (95%). The vaccine will have a major impact on HZ management. Phase I-II trials showed safety and immunogenicity in severely immunocompromised patients. Phase III trial results are expected soon.

KEYWORDS:

• Herpes zoster
• vaccine
• postherpetic neuralgia
• HZ/su vaccine
• adjuvants
• AS01_B
• reactogenicity

Information resources

Further information on the pivotal clinical trials ZOE-50 and ZOE-70 can be obtained at https://clinicaltrials.gov/numbers NCT01165177 and NCT01165229.

Declaration of interest

AL Cunningham has consulted on vaccines for Merck, BioCSL/Sequirus and GlaxoSmithKline and his institution has received resulting honoraria. T Heineman is a former employee of GlaxoSmithKline and has consulted with them since his departure. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This manuscript was not funded.