Review: Adjuvant recombinant subunit vaccine prevents herpes zoster more than live attenuated vaccine in adults ≥ 50 years

AbstractObjectiveTo compare the efficacy, effectiveness, and safety of the herpes zoster live attenuated vaccine with the herpes zoster adjuvant recombinant subunit vaccine or placebo for adults aged 50 and older.DesignSystematic review with bayesian meta-analysis and network meta-analysis.Data sourcesMedline, Embase, and Cochrane Library (inception to January 2017), grey literature, and reference lists of included studies.Eligibility criteria for study selectionExperimental, quasi-experimental, and observational studies that compared the live attenuated vaccine with the adjuvant recombinant subunit vaccine, placebo, or no vaccine in adults aged 50 and older. Relevant outcomes were incidence of herpes zoster (primary outcome), herpes zoster ophthalmicus, post-herpetic neuralgia, quality of life, adverse events, and death.Results27 studies (22 randomised controlled trials) including 2 044 504 patients, along with 18 companion reports, were included after screening 2037 titles and abstracts, followed by 175 full text articles. Network meta-analysis of five randomised controlled trials found no statistically significant differences between the live attenuated vaccine and placebo for incidence of laboratory confirmed herpes zoster. The adjuvant recombinant subunit vaccine, however, was statistically superior to both the live attenuated vaccine (vaccine efficacy 85%, 95% credible interval 31% to 98%) and placebo (94%, 79% to 98%). Network meta-analysis of 11 randomised controlled trials showed the adjuvant recombinant subunit vaccine to be associated with statistically more adverse events at injection sites than the live attenuated vaccine (relative risk 1.79, 95% credible interval 1.05 to 2.34; risk difference 30%, 95% credible interval 2% to 51%) and placebo (5.63, 3.57 to 7.29 and 53%, 30% to 73%, respectively). Network meta-analysis of nine randomised controlled trials showed the adjuvant recombinant subunit vaccine to be associated with statistically more systemic adverse events than placebo (2.28, 1.45 to 3.65 and 20%, 6% to 40%, respectively).ConclusionsUsing the adjuvant recombinant subunit vaccine might prevent more cases of herpes zoster than using the live attenuated vaccine, but the adjuvant recombinant subunit vaccine also carries a greater risk of adverse events at injection sites.Protocol registrationProspero CRD42017056389.

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Research shows that highly potent vaccine reduces the burden of herpes zoster and the incidence of postherpetic neuralgia in older adults

Weekly releases (1997–2007) ◽

10.2807/esw.10.23.02722-en ◽

2005 ◽

Vol 10 (23) ◽

Author(s):

B C Ciancio

Keyword(s):

Older Adults ◽

Herpes Zoster ◽

Postherpetic Neuralgia ◽

Double Blind Trial ◽

Double Blind ◽

Live Attenuated Vaccine ◽

Blind Trial ◽

Attenuated Vaccine

A live attenuated vaccine reduces the burden of herpes zoster (shingles) in older adults, according to the recently published results of a randomised, double-blind trial

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Early impact of the Australian national shingles vaccination program with the herpes zoster live attenuated vaccine

Human Vaccines & Immunotherapeutics ◽

10.1080/21645515.2020.1754702 ◽

2020 ◽

Vol 16 (12) ◽

pp. 3081-3089

Author(s):

John Litt ◽

Robert Booy ◽

Debra Bourke ◽

Dominic E. Dwyer ◽

Alan Leeb ◽

...

Keyword(s):

Herpes Zoster ◽

Vaccination Program ◽

Live Attenuated Vaccine ◽

Attenuated Vaccine

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P195: Co-administration of herpes zoster live-attenuated vaccine with polysaccharide pneumococcal-23 vaccine

European Geriatric Medicine ◽

10.1016/s1878-7649(14)70370-5 ◽

2014 ◽

Vol 5 ◽

pp. S145

Author(s):

I. Bertrand ◽

S. Thomas ◽

G. Kassianos

Keyword(s):

Herpes Zoster ◽

Live Attenuated Vaccine ◽

Attenuated Vaccine

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A Review on Dengue Vaccine Development

Vaccines ◽

10.3390/vaccines8010063 ◽

2020 ◽

Vol 8 (1) ◽

pp. 63 ◽

Cited By ~ 9

Author(s):

Sheng-Qun Deng ◽

Xian Yang ◽

Yong Wei ◽

Jia-Ting Chen ◽

Xiao-Jun Wang ◽

...

Keyword(s):

Global Health ◽

Subunit Vaccine ◽

Vaccine Development ◽

Clinical Use ◽

Risk Of Infection ◽

Vaccine Recombinant ◽

Dengue Vaccine ◽

Live Attenuated Vaccine ◽

Attenuated Vaccine ◽

Vectored Vaccine

Dengue virus (DENV) has become a global health threat with about half of the world’s population at risk of infection. Although the disease caused by DENV is self-limiting in the first infection, the antibody-dependent enhancement (ADE) effect increases the mortality in the second infection with a heterotypic virus. Since there is no specific efficient medicine in treatment, it is urgent to develop vaccines to prevent infection and disease progression. Currently, only a live attenuated vaccine, chimeric yellow fever 17D—tetravalent dengue vaccine (CYD-TDV), has been licensed for clinical use in some countries, and many candidate vaccines are still under research and development. This review discusses the progress, strengths, and weaknesses of the five types of vaccines including live attenuated vaccine, inactivated virus vaccine, recombinant subunit vaccine, viral vectored vaccine, and DNA vaccine.

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Immunogenicity generated by mRNA vaccine encoding VZV gE antigen is comparable to adjuvanted subunit vaccine and better than live attenuated vaccine in nonhuman primates

Vaccine ◽

10.1016/j.vaccine.2020.06.062 ◽

2020 ◽

Vol 38 (36) ◽

pp. 5793-5802 ◽

Cited By ~ 2

Author(s):

Morgan A. Monslow ◽

Sayda Elbashir ◽

Nicole L. Sullivan ◽

David S. Thiriot ◽

Patrick Ahl ◽

...

Keyword(s):

Subunit Vaccine ◽

Nonhuman Primates ◽

Live Attenuated Vaccine ◽

Attenuated Vaccine ◽

Better Than

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A Cost-Effectiveness Analysis of an Adjuvanted Subunit Vaccine for the Prevention of Herpes Zoster and Post-Herpetic Neuralgia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1043 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S416-S417

Author(s):

Christopher Carpenter ◽

Annas Aljassem ◽

Jerry Stassinopoulos ◽

Giovanni Pisacreta ◽

David Hutton

Keyword(s):

Herpes Zoster ◽

Cost Effectiveness ◽

Subunit Vaccine ◽

Cost Effective ◽

The United States ◽

Base Case ◽

Post Herpetic Neuralgia ◽

Cost Effectiveness Ratio ◽

Live Attenuated Vaccine ◽

The Cost

Abstract Background Herpes zoster (HZ) develops in up to 50% of unvaccinated individuals who live to 85 years of age, accounting for more than 1 million cases of HZ annually in the United States. A live attenuated vaccine (LAV) for HZ is U.S. FDA approved for persons 50 years or older, though CDC Advisory Committee on Immunization Practices (ACIP) recommendations are only for persons beginning at age 60 years. LAV efficacy at preventing HZ is ~70% for persons 50–59 years of age, with lower efficacy in older adults, and it is efficacious in preventing post-herpetic neuralgia (PHN) beyond the HZ prevention. The efficacy of LAV after vaccination wanes over time. A new adjuvanted HZ subunit vaccine (SUV), administered as a two-dose series, has greater than 95% efficacy against HZ in persons 50–69 years of age. SUV efficacy remains greater than 90% in persons vaccinated at age 70 years and older, including the subgroup older than 80 years of age. Overall efficacy of SUV against PHN approaches 90%. The waning rate of efficacy after SUV vaccination is unknown. Methods To estimate the relative cost-effectiveness of SUV, LAV and no vaccination (NV) strategies, a Markov model was developed based on published trials and data on vaccine efficacy persistence, quality of life, resource utilization, costs and disease epidemiology. The perspective was U.S. societal, and the cycle length was one year with a lifelong time horizon. SUV efficacy was estimated for the base case to wane at the same rate as LAV, all persons were assumed to receive both doses of SUV, and the cost of SUV included both doses. Results For individuals vaccinated at age 50 years the incremental cost-effectiveness ratio (ICER) for LAV vs. NV was $142,811 per quality-adjusted life-year (QALY); at age 60 years the ICER dropped to $59,482 per QALY. The cost-effectiveness ratio of SUV approached that of LAV when the SUV cost approached $500 for persons vaccinated at age 50 years and when the cost was $400 for those vaccinated at age 60 years. The SUV cost that would result in achieving an ICER target of $100,000 per QALY for SUV vaccination vs. NV at age 50 years was $316; at age 60 years the cost was $638. Conclusion Vaccination at age 60 years with SUV was more cost-effective than LAV when SUV cost was ~$450 or less. Vaccination with SUV at age 50 years appeared to be cost-effective if SUV cost was ~$315 or less. Disclosures All authors: No reported disclosures.

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Monitoring Interest in Herpes Zoster Vaccination: Analysis of Google Search Data (Preprint)

10.2196/preprints.10180 ◽

2018 ◽

Author(s):

Elyse J Berlinberg ◽

Michael S Deiner ◽

Travis C Porco ◽

Nisha R Acharya

Keyword(s):

Public Health ◽

Herpes Zoster ◽

Vaccine Coverage ◽

Application Programming Interface ◽

The United States ◽

Live Attenuated Vaccine ◽

Attenuated Vaccine ◽

Search Volume ◽

Search Data ◽

Google Search

BACKGROUND A new recombinant subunit vaccine for herpes zoster (HZ or shingles) was approved by the United States Food and Drug Administration on October 20, 2017 and is expected to replace the previous live attenuated vaccine. There have been low coverage rates with the live attenuated vaccine (Zostavax), ranging from 12-32% of eligible patients receiving the HZ vaccine. OBJECTIVE This study aimed to provide insight into trends and potential reasons for interest in HZ vaccination. METHODS Internet search data were queried from the Google Health application programming interface from 2004-2017. Seasonality of normalized search volume was analyzed using wavelets and Fisher’s g test. RESULTS The search terms “shingles vaccine,” “zoster vaccine,” and “zostavax” all exhibited significant periodicity in the fall months (P<.001), with sharp increases after recommendations for vaccination by public health-related organizations. Although the terms “shingles blisters,” “shingles itch,” “shingles rash,” “skin rash,” and “shingles medicine” exhibited statistically significant periodicities with a seasonal peak in the summer (P<.001), the terms “shingles contagious,” “shingles pain,” “shingles treatment,” and “shingles symptoms” did not reveal an annual trend. CONCLUSIONS There may be increased interest in HZ vaccination during the fall and after public health organization recommendations are broadcast. This finding points to the possibility that increased awareness of the vaccine through public health announcements could be evaluated as a potential intervention for increasing vaccine coverage.

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Neutralizing response of rabbits to an experimental rubella subunit vaccine made from immunostimulating complexes

Canadian Journal of Microbiology ◽

10.1139/m88-238 ◽

1988 ◽

Vol 34 (12) ◽

pp. 1351-1354 ◽

Cited By ~ 7

Author(s):

Michel Trudel ◽

Francine Nadon ◽

Cécile Séguin ◽

Pierre Payment

Keyword(s):

Subunit Vaccine ◽

Viral Proteins ◽

Live Vaccine ◽

Live Attenuated Vaccine ◽

Attenuated Vaccine ◽

Immunostimulating Complexes

The purpose of this study was to evaluate experimentally the immunogenicity in rabbits of rubella subunits adsorbed to the adjuvant Quil A. The adsorbed viral proteins form structurally defined ImmunoStimulating COMplexes (ISCOMs). Rubella ISCOMs were tested for their capacity to induce neutralizing and hemagglutination-inhibiting antibodies, in comparison with a commercial live attenuated vaccine. Rubella ISCOMs were as efficient as the live vaccine in inducing neutralizing and hemagglutination inhibiting antibodies, suggesting the possibility of developing an ISCOMs subunit vaccine.

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