CDC's Shingles Vaccine Recommendation Revisited
After reviewing evidence on the safety and efficacy of the herpes zoster vaccine in adults ages 50–59, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) has decided to maintain the current recommendation of routine herpes zoster immunization in adults aged ≥60 years of age. The ACIP review summary was published in the CDC's Morbidity and Mortality Weekly Report (MMWR).
In 2006, the Food and Drug Administration approved the varicella zoster vaccine (Zostavax; Merck & Co.) for the prevention of herpes zoster in adults ≥60 years and recommended by the ACIP in 2008. The indication was expanded in 2011 for adults ages 50–59 but the ACIP declined recommending the vaccine in this age group due to vaccine shortages and limited data on long-term protection of the vaccine in this population.
The ACIP revisited the current recommendations in October 2013 by assessing new research on the efficacy and duration of herpes zoster immunization in adults ages 50–59. A study of 22,439 adults in this age group showed efficacy of 69.8% for the prevention of herpes zoster over an average follow-up period of 1.3 years (95% CI: 54.1%–80.6%).
The panel also reviewed a cost-effectiveness analysis comparing health care resource utilization, costs, and quality-adjusted life years (QALYs) associated with herpes zoster, postherpetic neuralgia (PHN), and non-pain complications among unvaccinated persons and persons vaccinated at either age 50, 60, or 70 years. Receiving the vaccine at age 60 was predicted to prevent the most herpes zoster cases (26,147 cases per 1 million persons), followed by vaccination at age 70 years and age 50 years (preventing 21,269 and 19,795 cases, respectively). Vaccination at age 70 would also prevent the most cases of PHN. This cost-effectiveness model predicted a substantially greater reduction of disease burden, health care utilization, and costs with immunization of older adults who have higher incidence of herpes zoster and related complications.
After agreeing to maintain the current recommendation of routine herpes zoster vaccination in adults ages ≥60 years, the ACIP agreed to re-evaluate the optimal age for vaccination as additional data becomes available.
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