Shingles

A natural experiment on the effect of herpes zoster vaccination on dementia

A natural experiment on the effect of herpes zoster (shingles) vaccination offers additional evidence of a dementia-preventing or dementia-delaying effect from zoster vaccination that is less biased than the existing associational evidence.

This new finding is essential as dementia affects more than 55 million people worldwide, with an estimated 10 million new cases every year.

A pivotal study published in the journal Nature on April 2, 2025, reinforces the evidence that standard shingles vaccines may significantly protect older adults against dementia.

Researchers from Stanford Medicine and the Vienna University of Economics and Business analyzed health records of Welsh adults aged 71 to 88.

They found that vaccinated individuals were about 20% less likely to develop dementia over the next seven years compared to those who were not vaccinated.

The authors cautioned that prior studies linking vaccines to improved health outcomes often face scrutiny because vaccinated individuals tend to have healthier behaviors.

In a press release, Dr. Pascal Geldsetzer, the study's senior author, stated, "These associational studies struggle with a fundamental issue: people who get vaccinated generally have different health behaviors than those who do not."

This new finding highlights the need for further research to fully understand the benefits of the shingles vaccine for older adults.

According to the U.S. CDC, shingles causes a painful rash. It results from the reactivation of the varicella-zoster virus in adults who typically contracted chickenpox in childhood. The virus remains dormant in the nerve cells for the rest of its life.

In individuals who are older or have weakened immune systems, the dormant virus can reactivate, causing shingles.

Previously, the journal BMC Public Health published results from a study on October 2, 2023, concluding that both the zoster vaccine for preventing shingles and herpes zoster, as well as the influenza vaccine, were associated with a diminished risk of dementia.

This study concluded that the association of herpes-zoster vaccination appeared more pronounced.

And a non-peer-reviewed study published on May 25, 2023, reported that shingles vaccinations were associated with a 19.9% lower risk of dementia.

As of April 2025, various shingles vaccines are offered globally.

Furthermore, the U.S. CDC recommends vaccinations for eligible seniors, which are available at clinics and pharmacies.

Note: This news article was updated on April 23, 2025.

Sub Title:

Shingles vaccines are available worldwide in 2025

References:

The association of herpes zoster and influenza vaccinations with the risk of developing dementia: a population-based cohort stud

Does shingles vaccination cut dementia risk? Large study hints at a link

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Shingles Vaccination May Reduce Dementia

Karen McClorey Hackett — Wed, 14 Aug 2024 10:17:21 +0000

Reviewer:

Herpes zoster and long-term risk of subjective cognitive decline

With an aging population, age-related cognitive decline is an increasing health burden for families and society. Recently, there has been scientific evidence indicating that herpesviruses may influence the risk of cognitive decline, such as dementia.

A recent study published in Alzheimer's Research & Therapy revealed that individuals who have had herpes zoster (HZ, shingles) may have a 20% higher risk of experiencing subsequent subjective cognitive decline (SCD) over the long term.

This large-scale study is the first to explore the connection between shingles and the risk of subjective cognitive decline. However, this link between the shingles virus and cognition is not fully understood.

These researchers wrote on August 12, 2023, that evidence on the longitudinal association between shingles and cognitive decline is conflicting, and whether the risk differs by the APOE ε4-carrier gene status has not been studied.

To investigate this association, Brigham and Women's Hospital researchers examined survey data from 149,327 individuals.

Compared with individuals with no history of shingles, the multivariable-adjusted relative risk (MVRR) (95% CI) of a 3-unit increment in SCD score was significantly and independently higher among individuals with a history of HZ.

Still, the duration of time since HZ, when the elevated risk of SCD was statistically significant, differed among the study cohorts.

Among the subset of women with information on HZ vaccination, there was a suggestion that the long-term risk of SCD may be greater among women who were not vaccinated against HZ.

The study also found that men with shingles who carry the APOE4 gene, a known risk factor for dementia, had an even higher risk of subjective cognitive decline. About 25% of people carry one copy of APOE4, and 3% may carry two copies.

These researchers noted that this increased risk was observed in men but not women.

Previous research has yielded mixed evidence on the link between shingles and dementia, possibly because some studies only included individuals who sought medical attention for them using insurance claims or administrative diagnostic data, wrote these researchers.

Regarding herpes zoster prevention, there are various shingles vaccines available globally.

In the United States, GSK's Shingrix®, a non-live, adjuvanted recombinant shingles vaccine, is offered by clinics and most pharmacies. Furthermore numerous health insurance programs cover most of the cost related to vaccination.

Sub Title:

Herpes zoster vaccine associated with reduced subjective cognitive decline

References:

APOE4 gene may increase risk for dementia

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by Mircea Iancu

Herpes Zoster Vaccination Associated with Delay in Dementia

Donald Hackett — Sat, 27 Jul 2024 12:55:29 +0000

Reviewer:

The recombinant shingles vaccine is associated with lower risk of dementia

According to a new study published by the journal Nature Medicine, there is emerging evidence that the live herpes zoster (shingles) vaccine might protect against dementia.

However, whether the GlaxoSmithKline plc's Shingrix® recombinant shingles vaccine protects against dementia remains unknown.

This Brief Communication, published on July 25, 2024, stated, 'We used a natural experiment opportunity created by the rapid transition from live to recombinant vaccines to compare the risk of dementia between vaccines. We show that the recombinant vaccine is associated with a significantly lower risk of dementia in the six years post-vaccination.'

'Specifically, receiving the recombinant vaccine is associated with a 17% increase in diagnosis-free time, translating into 164 additional days lived without a diagnosis of dementia in those subsequently affected.'

'The effect was robust across multiple secondary analyses and present in both men and women but greater in women.'

'These findings should stimulate studies investigating the mechanisms underpinning the protection and could facilitate the design of a large-scale randomized control trial to confirm the possible additional benefit of the recombinant shingles vaccine.'

'The recombinant shingles vaccine was also associated with lower risks of dementia compared to two other vaccines commonly used in older people: influenza and tetanus/diphtheria/pertussis vaccines.'

John Todd, Professor of Precision Medicine at the University of Oxford’s Nuffield Department of Medicine, commented in a press release, 'A key question is, how does the vaccine produce its apparent benefit in protecting against dementia? One possibility is that infection with the Herpes zoster virus might increase the risk of dementia, and therefore, by inhibiting the virus, the vaccine could reduce this risk.'

'Alternatively, the vaccine also contains chemicals which might have separate beneficial effects on brain health,' added Todd.

Researchers at the University of Oxford conducted this study, which included about 200,000 people, and it was funded by the National Institute for Health and Care Research Oxford Health Biomedical Research Centre.

Sub Title:

Recombinant Shingrix vaccine may reduced risk of dementia

References:

New shingles vaccine could reduce risk of dementia

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Healthy Retirement Found in Caribbean Islands

Karen McClorey Hackett — Sun, 11 Dec 2022 23:47:29 +0000

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Easy Citizenship for Retirement

In the long run, we're all working to retire sooner than later. While everyone has different visions for this scenario, one option shared by many is moving to an island for retirement.

GOBankingRates recently outlined the 15 cheapest countries to retire to on December 9, 2022, but not all are equal regarding gaining citizenship and avoiding disease.

There is one country located in the Caribbean Sea that makes it easy to gain citizenship and live a healthy life.

The Dominican Republic (D.R.) is located in the eastern section of Hispaniola in the Greater Antilles archipelago of the Caribbean.

It is the second largest, most diverse Caribbean country and is a quick two-hour flight from Florida.

According to GOBankingRates, the D.R. has a short wait period to obtain citizenship.

The essential requirement for citizenship comes down to an income of at least $1,500 a month as a retiree, passing a medical exam, then establishing permanent residence in the D.R. for two years.

Furthermore, the U.S. Centers for Disease Control and Prevention (CDC) strongly encourages everyone over 65 years of age to boost their immune system to prevent disease in retirement.

One method of achieving this goal is by maximizing vaccine protections.

A clear example for seniors is shingles, also known as herpes zoster.

About one out of every three people in the U.S. will develop shingles during their life. With the risk of shingles increases as you get older.

The good news is shingles can be prevented by vaccination.

The U.S. FDA approved the Shingrix® vaccine in 2017.

Since then, various clinical studies have confirmed its effectiveness and safety.

The CDC also recommends various basic (measles) and travel (dengue) vaccination for anyone visiting the D.R.

And if you plan to visit Brazil, yellow fever vaccination may be required.

The U.S. Department of State advised travelers on December 5, 2022, if they are a lawful permanent resident (LPR) who has been outside of the U.S. for less than a year but their resident card ("green card") is lost or damaged, you will need to apply for a travel document, also known as a "boarding foil."

However, if your 10-year LPR card is expired, you do not need a boarding foil.

For in-country assistance, the U.S. Embassy in the Dominican Republic is located at Av. Republica de Colombia #57 in Santo Domingo. The embassy's local telephone number is: (809) 567-7775.

Vax-Before-Travel publishes fact-checked, research-based travel information manually curated for mobile readers.

Sub Title:

Dominican Republic offers easy retirement options

References:

15 Cheapest Countries For Retirement

CDC - Shingles Zoster

DR vaccine suggestions

U.S. Dept of State Embassy

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Herpes Zoster Risk Increased by 15% Following COVID-19

Karen McClorey Hackett — Mon, 02 May 2022 14:32:09 +0000

Reviewer:

Increased Risk of Herpes Zoster in Adults ≥50 Years Old Diagnosed With COVID-19 in the United States

Holly Lutmer PharmD

Since the start of the COVID-19 pandemic, several case reports have been published describing Herpes Zoster (HZ) cases in COVID-19 patients.

As a SARS-CoV-2 coronavirus infection can result in T-cell immune dysfunction, it was hypothesized that this could trigger latent HZ reactivation.

A recent peer-reviewed study was the first large, retrospective cohort study designed to investigate the hypothesis that COVID-19 could increase the risk of HZ.

This study found that older adults diagnosed with COVID-19 have a 15% increased risk of developing HZ than those never diagnosed with COVID-19.

And the increased HZ risk was more pronounced (21%) following COVID-19 hospitalization.

These findings highlight the importance of getting and maintaining HZ immunization.

And these researchers stated, ‘healthcare professionals should consider that COVID-19 may be a risk factor for HZ.’

HZ, also known as shingles, is caused by the reactivation of latent varicella-zoster virus (VZV) and is characterized by a painful, vesicular, dermatomal rash.

Shingles can be prevented with an effective and safe U.S. FDA-approved vaccine.

In the U.S., the Shingrix vaccine has been available since 2017 at most clinics and pharmacies.

On June 25, 2021, the U.S. CDC reviewed 'Zoster Vaccines Session: Burden of Herpes Zoster in Immunocompromised Adults' and GSK's presentation: 'Use of Recombinant Zoster Vaccine in Immunocompromised Populations.'

And the CDC published updated zoster vaccination schedules in February 2022.

Volume 9, May 2022, Open Forum Infectious Diseases initially published this study on March 9, 2022. This study matched 394,677 individuals ≥50 years old diagnosed with COVID-19 with over 1.5 million individuals never diagnosed with COVID-19.

The individuals with COVID-19 were exact-matched 1:4 to those without COVID-19 by age, sex, presence of HZ risk factors, and health care cost level.

This study had several strengths, such as using a Poisson regression model to adjust any variables that showed an imbalance between the COVID-19 and non-COVID-19 cohorts despite matching, thereby further controlling for possible confounding. And the study’s limitations included those inherent to retrospective research-based on claims data.

GlaxoSmithKline Biologicals S.A supported this work and these researchers disclosed their relationship with the company.

A previous population-based study published by The Lancet in February 2022, ‘identified an increased risk of HZ-related hospitalization after CoronaVac and BNT162b2 vaccinations.

PrecisionVaccinations publishes fact-checked research-based vaccine news.

Sub Title:

Herpes zoster vaccination recommended for most adults

References:

Herpes zoster related hospitalization after inactivated (CoronaVac) and mRNA (BNT162b2) SARS-CoV-2 vaccination: A self-controlle

Herpes zoster following COVID-19 vaccination in an immunocompetent and vaccinated for herpes zoster adult: A two-vaccine related

Association study between herpes zoster reporting and mRNA COVID-19 vaccines (BNT162b2 and mRNA-1273)

CDC: Use of Recombinant Zoster Vaccine (RZV) in Immunocompromised Populations

Zoster Vaccines Session: Burden of Herpes Zoster in Immunocompromised Adults

Shingrix Shingles Vaccine

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Shingles Vaccination Rates Significantly Increased With Seniors

Don Hackett — Tue, 14 Jul 2020 23:47:04 +0000

Reviewer:

CDC: Shingles Vaccination Among Adults Aged 60 and Over

The number of senior Americans who report receiving a shingles vaccination had risen steadily since 2008, new data from the Centers for Disease Control and Prevention's (CDC's) National Center for Health Statistics revealed

The proportion of people in this age group (60+) who were vaccinated rose from 6.7 percent in 2008 to 34.5 percent in 2018, reported the CDC on July 9, 2020.

While there has been a shingles vaccine available since 2006, a new vaccine was introduced in late 2017, and uptake in the market may have occurred differentially in 2018, stated the CDC.

Also in 2017, the CDC’s vaccine committee expanded their recommendation for shingles vaccination to adults aged 50 and over.

Prior to this change (starting in 2008), shingles vaccination was only recommended for those aged 60 and over.

According to this new data, shingles vaccination did not differ by sex, but non-Hispanic white adults were more likely to have ever received this vaccine compared with Hispanic and non-Hispanic black adults.

However, shingles vaccination increased with educational attainment, as well as with increasing family income.

Additionally, regional differences were observed in receipt of shingles vaccination.

Shingles is a painful rash caused by the varicella-zoster virus. Persons of all ages are at risk for shingles.

Shingles rashes usually develop on one side of the body, often the face or torso. The rash consists of blisters that typically scab over in 7 to 10 days and clears up within 2 to 4 weeks.

Some people describe the pain as an intense burning sensation.

For some people, the pain can last for months or even years after the rash goes away.

This long-lasting pain is called postherpetic neuralgia (PHN), and it is the most common complication of shingles.

Moreover, this risk and the risk of complications from shingles case increases with age.

Two vaccines are licensed in the USA to prevent shingles and PHN, Zostavax, and Shingrix.

Zoster vaccine live (ZVL, Zostavax) has been used since 2006. Zostavax may still be used to prevent shingles in healthy adults 60 years and older.

For example, you could use Zostavax if a person is allergic to Shingrix, prefers Zostavax, or requests immediate vaccination and Shingrix is not available.

On May 22, 2020, Merck notified healthcare providers that it will no longer sell Zostavax in the USA, effective July 1, 2020.

And, the recombinant zoster vaccine (RZV, Shingrix) has been used since 2017. Shingrix is now recommended by the CDC as the preferred shingles vaccine.

Data from the 2008–2018 NHIS were used for this analysis. NHIS is a nationally representative household survey of the civilian noninstitutionalized U.S. population.

Shingles vaccination news is published by Precision Vaccinations.

Sub Title:

Shringrix is the recommended vaccine to prevent shingles in the USA

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Shingrix Shingles Vaccine

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Shingles Vaccination Reduced Stroke Risk By 16%

Don Hackett — Thu, 13 Feb 2020 23:07:13 +0000

Reviewer:

Shingles vaccine may also reduce stroke risk

A new study conducted by the Centers for Disease Control and Prevention (CDC) indicates that the shingles vaccine could reduce an individual's risk of stroke.

The results of this study announced on February 12, 2020, suggest that vaccination with the Zoster Vaccine Live reduced stroke risk by 16 percent in seniors.

This shingles prevention vaccine was initially approved in the USA during 2006 and is known as Zostavax.

To help determine if the shingles vaccine reduces the risk of stroke, Quanhe Yang, Ph.D., lead study author and senior scientist at the CDC and colleagues reviewed the Medicare health records of more than 1 million Medicare fee-for-service beneficiaries age 66 or older who had no history of stroke and who were vaccinated with the Zoster Vaccine Live between 2008 and 2014.

That group was matched with the same number of Medicare fee-for-service beneficiaries who did not receive the shingles vaccine with the same four-year follow-up.

These researchers found:

Receiving the shingles vaccine lowered the risk of stroke by about 16%,
Lowered the risk of ischemic (clot-caused) stroke by about 18%, and
Lowered the risk of hemorrhagic (bleeding) stroke by about 12%;

Furthermore, Zostavax’s protection was strongest among people ages 66 to 79 years.

“The reason for increased risk of stroke after a shingles infection may be due to inflammation caused by the virus,” according to Dr. Yang.

“Our study results may encourage people ages 50 and older to follow the recommendation and get vaccinated against shingles.”

“You are reducing the risk of shingles, and at the same time you may be reducing your risk of stroke.”

The newest shingles vaccine known as Shingrix, Adjuvanted, Non-Live Recombinant Shingles Vaccine (available since 2017), confers even greater protection and is now the preferred vaccine recommended by the CDC’s Advisory Committee on Immunization Practices.

According to the CDC, 2-doses of Shingrix is more than 90 percent effective at preventing shingles and is recommended for adults age 50 and older.

More than 99 percent of people aged 40 or older in the USA carry the dormant chickenpox virus, also known as the varicella-zoster virus, says the CDC.

Shingles is a reactivation of the chickenpox virus and typically occurs after age 50.

The risk of developing shingles, a painful condition that causes skin blisters and can have serious complications, increases with age and other health conditions.

Future studies are needed to confirm the link between Zoster Vaccine Live and stroke and to determine any association between Adjuvanted, Non-Live Recombinant Shingles Vaccine, and the risk for stroke.

This study’s findings will be presented at the American Stroke Association’s International Stroke Conference, Poster Presentation TP493. Co-authors are Anping Chang, M.S.; Xin Tong, M.P.H.; and Robert Merritt, M.A. Author disclosures are available in the abstract.

Statements and conclusions of study authors that are presented at American Stroke Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position.

The CDC funded this study.

Shingles vaccine news published by Precision Vaccinations.

Sub Title:

Inflammation caused by the varicella-zoster virus may increase stroke risks after a shingles infection

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Shingles Vaccination Found Safe For Seniors With Inflammatory Conditions

Don Hackett — Sun, 10 Nov 2019 22:33:20 +0000

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Results from a Randomized Controlled Trial of the Safety of the Live Varicella Vaccine in TNF-Treated Patients

According to a new clinical study led by researchers from the University of Alabama at Birmingham, the live zoster virus vaccine (Zostavax) was found to be safe for people who are currently receiving tumor necrosis factor inhibitor (TNFi) biologic therapies for various indications.

The randomized VERVE clinical trial comprised 617 patients receiving TNFi for multiple indications, observed no cases of vaccine-related varicella infection or reactivation, in the 6-week risk period following live zoster vaccination.

The VERVE participants' TNFi indications included 59 percent with rheumatoid arthritis (RA) and 24.5 percent with psoriatic arthritis (PsA).

This is good news for seniors with rheumatic conditions desiring to be protected from a Shingles outbreak or postherpetic neuralgia (PHN), the most common complication of herpes zoster.

Herpes zoster is caused by the reactivation of the varicella-zoster virus, the same virus that causes varicella (chickenpox), says the Centers for Disease Control and Prevention (CDC).

A person’s risk of having PHN after herpes zoster increases with age. Approximately 10 to 13 percent of people 60 years and older with herpes zoster will get PHN.

Moreover, the CDC says people with compromised or suppressed immune systems are more likely to have complications from herpes zoster.

These researchers found ‘in healthy individuals, excess TNF in the blood is modulated naturally, but in those who have rheumatic conditions, higher levels of TNF in the blood and joints lead to more inflammation and persistent symptoms.’

And, ‘medications that block TNF can alter a disease's effect on the body by controlling inflammation in the joints, gastrointestinal tract, and skin.’

"Shingles manifests in most patients as a painful blistering rash that lasts a few weeks, but serious complications such as disseminated disease, eye involvement, and even strokes can occur," said Jeffrey R. Curtis, M.D., MS, MPH, a professor of medicine at the University of Alabama at Birmingham's Division of Clinical Immunology and Rheumatology, and the study's lead author.

"While the need for prevention in patients with rheumatic diseases is compelling, the use of any weakened (attenuated) live virus vaccine is potentially a safety risk. There is a theoretical risk that a live virus vaccine could give a patient the weakened form of infection.”

“A major goal of the trial was to understand the safety of this live virus vaccine and to see if it caused infection in any of the participants,” said Dr. Curtis, in a press release.

Through the 6th week, these researchers observed 0 cases of confirmed disseminated or local varicella infection of either wild-type or vaccine strain.

This result yielded an upper bound of the 95 percent confidence interval for a vaccine-related varicella infection rate of approximately 1 percent. Eight patients that did develop a rash were tested for varicella by PCR, but none were positive for infection.

The researchers closed the VERVE trial in Summer 2019 to a blinded follow-up and will report the immunologic effectiveness of ZV in the full cohort at the ACR/ARP Annual Meeting on November 10, 2019, in Abstract #824.

"The clinical significance of the trial is to provide high-quality direct evidence of the safety of this live virus vaccine in patients who previously were warned not to use it because of the theoretical risk for it to cause infection," said Dr. Curtis.

"It also opens the door for the idea that for TNFi users, perhaps other live virus vaccines, also may be safe and might be considered in certain circumstances.”

“A trial of this new shingles vaccine (Shingrix) is being planned for these patients and likely will begin in 2020, Dr. Curtis concluded.

TNF inhibitors are a group of medications used worldwide to treat inflammatory conditions such as rheumatoid arthritis, psoriatic arthritis, juvenile arthritis, inflammatory bowel disease (Crohn’s and ulcerative colitis), ankylosing spondylitis, and psoriasis.

They reduce inflammation and can stop disease progression by targeting TNF.

There are 6 different TNF inhibitors that have been approved by the U.S. Food and Drug Administration for the treatment of rheumatic diseases.

To decrease side effects and costs, most patients with mild or moderate disease may be treated with methotrexate before adding or switching to a TNF inhibitor.

These agents can be used by themselves or in combination with other medications such as prednisone, methotrexate, hydroxychloroquine, leflunomide, or sulfasalazine, reported this study.

Recent Shingles vaccine news

September 26, 2019 – A Seattle-based biotechnology company announced encouraging preliminary Phase I study results of their Shingles vaccine candidate, CRV-101.
August 8th, 2019 – According to Nakul Shekhawat, M.D., and his colleagues at the University of Michigan, the incidence of herpes zoster ophthalmicus —shingles of the eye—had tripled in the United States from 2004 to 2016.

According to the CDC, shingles vaccination has been available in the United States since 2006 with the approval of the Zostavax a live zoster vaccine. Since then, this vaccine has been recommended for routine use in all adults aged 60 years or older and is now approved for use in adults aged 50 years or older.

In October 2017, the Advisory Committee on Immunization Practices (ACIP) of the CDC issued a recommendation for use of a new shingles vaccine called Shingrix a recombinant zoster vaccine.

The new UAB research was supported by the NIH's National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Shingles vaccine news is published by Precision Vaccinations

Sub Title:

Live zoster vaccine reported effective for seniors taking tumor necrosis factor inhibitors

References:

TNF Inhibitors

NIH: Safety and Effectiveness of Live Zoster Vaccine in Anti-TNF Users (VERVE Trial)

Safety and Effectiveness of Live Zoster Vaccine in Anti-Tumor Necrosis Factor (TNF) Users (VERVE Trial)

Live zoster vaccine safe and effective for people taking TNF inhibitors

CDC: Shingles (Herpes Zoster)

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Shingles Vaccine Candidate Presented Preliminary Positive Phase 1 Results

Don Hackett — Thu, 26 Sep 2019 18:55:53 +0000

Reviewer:

GC Pharma to Establish Curevo - a Seattle-based New Company Dedicated to Development of New Vaccines

A Seattle-based biotechnology company announced encouraging preliminary Phase I study results of their Shingles vaccine candidate, CRV-101.

The interim trial results presented by leaders from Curevo, Inc., at the 44th annual International Herpesvirus Workshop on September 26, 2019, demonstrate a promising safety and tolerability profile of the CRV-101 vaccine in 90 healthy adults.

Key Findings of the Phase I Trial are as follows:

The vaccine was found safe and well-tolerated at all doses,
No Grade 3 or Grade 4 local reactogenicity,
One Grade 3 systemic adverse event (fever) in the highest dose cohort.
The proportion of participants experiencing soreness at the injection site was <10%.

Dr. Corey Casper, who led the study and serves as the President and Chief Executive Officer for Infectious Disease Research Institute, said in a related press release, “Immunologic analyses are ongoing, but we believe that CRV-101 may be an important addition to current vaccines for Shingles as the manufacturing process should allow it to be widely available and the components of the vaccine appear minimally toxic.”

This data was last updated on August 12, 2019, from the Phase 1, Randomized, Placebo-Controlled, Observer-Blind, Antigen Dose-Escalation, and Adjuvant Dose-Ranging Clinical Trial to Evaluate the Safety, Tolerability, and Immunogenicity of CRV-101 in (90) Healthy Adult Subjects.

This phase 1 study is located in Kansas City, Missouri, with the Principal Investigator John E. Ervin, M.D.

Recent shingles vaccine news

According to the Centers for Disease Control and Prevention (CDC), shingles vaccination has been available in the United States since 2006 with the approval of the Zostavax a live zoster vaccine. Since then, this vaccine has been recommended for routine use in all adults aged 60 years or older and is now approved for use in adults aged 50 years or older.

In October 2017, the Advisory Committee on Immunization Practices (ACIP) of the CDC issued a recommendation for use of a new shingles vaccine called Shingrix a recombinant zoster vaccine.

Shingles is a painful rash that develops on one side of the face or body. The rash consists of blisters that typically scab over in 7 to 10 days and fully clear up within 2 to 4 weeks, says the CDC.

Most commonly, the rash occurs in a single stripe around either the left or the right side of the body. In other cases, the rash occurs on one side of the face. Shingles on the face can affect the eye and cause vision loss. In rare cases (usually in people with weakened immune systems), the rash may be more widespread on the body and look similar to a chickenpox rash.

This long-lasting pain is called postherpetic neuralgia (PHN), and it is the most common complication of shingles.

The risk of getting shingles and PHN increases as people age.

Curevo’s clinical development plans include a Phase II study of CRV-101 in adults to optimize dose selection and assess preliminary efficacy.

Curevo Inc. has a goal to rapidly advance innovative new vaccine candidates from the research laboratory to the clinic by joining forces with South Korean Mogam Institute for Biomedical Research, GC Pharma, and the Infectious Disease Research Institute based in Seattle, Washington.

Shingles news is published by Precision Vaccinations

Sub Title:

Curevo shingles vaccine candidate CRV101 reported initial safety and tolerance results

References:

Safety, Tolerability, and Immunogenicity of CRV-101 in Healthy Adult Subjects

Curevo Announces FDA Advancement of IND Application for CRV-101, New Shingles Vaccine Candidate

Curevo Vaccine Announces Interim Results of Phase I Clinical Trial of CRV-101

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Shingrix Vaccine Found ‘Cost-Effective’ in Canada

Don Hackett — Mon, 26 Aug 2019 21:34:19 +0000

Reviewer:

John Paul Sanchez, PharmD

Kelley Lu, PharmD

A new study found vaccinating older adults against shingles in Canada is likely cost-effective and the Shingrix vaccine appears to provide seniors better protection than the Zostavax vaccine.

The study, published on August 26, 2019, used a model to compare the effectiveness and cost-effectiveness of the recombinant subunit (RZV, Shingrix) and live attenuated zoster (LZV, Zostavax) vaccines in adults aged 50 years and older in Canada.

The Zostavax vaccine has been available in Canada since 2008, and Shingrix was approved in 2017.

This study concluded, saying, ‘the number of people needed to be vaccinated to prevent 1-case of shingles was lower for Shingrix than for Zostavax, for all ages.’

About 30 percent of Canadians develop shingles (Herpes zoster) in their lifetime and the severity increases after age 50, according to Canada's Immunization Guide.

"Our model predicted that the recombinant subunit zoster vaccine is likely cost-effective in Canada for adults 60 years or older and that it provides greater health benefits than the live attenuated zoster vaccine for all age groups," wrote Dr. Marc Brisson, Centre de research du Centre Hospitalier de l'Université de Québec and the Université Laval, Québec, Quebec, with coauthors, in a press release.

The study's authors say the cost-effectiveness analysis was persuasive enough to convince the Canadia National Advisory Committee on Immunization (NACI) to recommend that adults 50 years of age and older be vaccinated with Shingrix.

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"Shingrix can help save patients, hospitals, and government money by decreasing the number of hospital/ER visits. This vaccine is very effective when it comes to preventing/protecting against the shingles virus which results in everyone saving money long term," said Nina Sprague, pharmacy intern for Brookshire's Grocery Company.

The NACI currently says ‘vaccinating adults 65 to 79 years of age would be most cost-effective.’

The study results are consistent with other economic evaluations in the United States and the Netherlands, said these researchers.

Recently, a JAMA article published on August 19, 2019, reported the US Centers for Disease Control and Prevention (CDC) vaccination committee recommended Shingrix over Zostavax for all immunocompetent persons, for those with chronic medical conditions (eg, chronic kidney disease, diabetes, chronic lung disease), and for persons aged 50 years or older receiving low-dose immunosuppressive therapy (at 0 months and at 2-6 months), including those who previously received Zostavax (at ≥2 months after dose) or had a prior episode of shingles.

Furthermore, according to Nakul Shekhawat, M.D., and his colleagues at the University of Michigan, the incidence of herpes zoster ophthalmicus (HZO)—shingles of the eye—had tripled in the United States from 2004 to 2016.

In this JAMA article published on August 7, 2019, one of the leading reasons behind this increase in older adults having HZO is waning cell-mediated immunity, which leaves them vulnerable to reactivation of varicella virus, which causes shingles.

Dr. Shekhawat’s study data of 21 million adults enrolled in insurance plans, showed that older age is also a risk factor for HZO.

The Canadian study was funded by the Public Health Agency of Canada, Quebec's ministry of health and social services, the Canadian Institutes of Health Research and Quebec's funding agency for health research. One of the authors reported receiving research grants or reimbursement for travel expenses from four vaccine manufacturers,

Published by Precision Vaccination

Sub Title:

Shingrix is a recombinant non-live vaccine that was approved in Canada during 2017

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Effectiveness and cost-effectiveness of vaccination against herpes zoster in Canada: a modelling study

Shingles vaccination of older adults cost-effective in Canada

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Adult Immunization Update

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Adult Immunization Schedule Updated

Don Hackett — Wed, 21 Aug 2019 20:25:39 +0000

Every year in the United States, thousands of adults become seriously ill and are hospitalized because of diseases that vaccines can help prevent.

The need for vaccines does not go away with age. In fact, there are specific ages in your adult life when vaccinations are recommended.

Immunization guidelines for adults are routinely updated when the US Food and Drug Administration (FDA) makes changes.

According to a JAMA article published on August 19, 2019, there have been 2 important vaccines approved by the FDA for adults, which are as follows:

Shingrix

Shingrix, a herpes zoster vaccine containing a specific protein subunit of the virus (recombinant glycoprotein E) with a novel adjuvant (an added substance that enhances or prolongs the immunologic response). Shingrix, a new recombinant herpes zoster vaccine approved by the FDA on October 20, 2017, is more efficacious than the older live-attenuated Zostavax (efficacy of >90% vs 51%, respectively).
The ACIP recommends Shingrix over Zostavax for all immunocompetent persons, for those with chronic medical conditions (eg, chronic kidney disease, diabetes, chronic lung disease), and for persons aged 50 years or older receiving low-dose immunosuppressive therapy (at 0 months and at 2-6 months), including those who previously received Zostavax (at ≥2 months after dose) or had a prior episode of shingles.
A recent study showed Shingrix reduced the incidence of herpes zoster in adults who had undergone autologous hematologic stem cell transplantation. Testing for varicella-zoster antibody prior to vaccination is not recommended.

Heplisav-B

Heplisav-B, a single-antigen recombinant hepatitis B vaccine with a novel adjuvant. In 2017, the recombinant hepatitis B vaccine (HBV), Heplisav-B, was approved by the FDA for adults aged 18 years or older.
It is a combination of HBV surface antigen (HBsAg; 20 µg) and Dynavax’s proprietary TLR9 agonist (a synthetic cytidine-phosphate-guanosine oligonucleotide, CpG 1018 adjuvant) and was designed to stimulate a directed immune response to HBsAg.
Heplisav-B is administered as a 2-dose series at 0 month and at 1 month. Currently, the ACIP does not endorse one hepatitis B vaccine over another; however, Heplisav-B requires only 2-doses and evidence suggests it is more immunogenic.

The vaccines you need as an adult are determined by many factors including your age, lifestyle, health condition, and which vaccines you’ve received during your life.

The 2019 adult vaccination schedule can be found here.

The FDA says ‘talk to your healthcare professional about which vaccines are right for you.’

The corresponding author for this JAMA article is Beverly E. Sha, MD, Rush University Medical Center, Division of Infectious Diseases, 600 S Paulina, Ste 140-143, Chicago, IL 60612 (beverly_sha@rush.edu).

Sub Title:

Shingrix and Heplisav-B vaccines now recommended for adults

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HEPLISAV-B

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Shingles of the Eye Increasing

Don Hackett — Thu, 08 Aug 2019 21:19:25 +0000

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Increasing Cases of Shingles in the Eye Raise Key Questions

Just about every US-born adult over the age of 40 years has been infected with the varicella-zoster virus, which causes chickenpox.

According to Nakul Shekhawat, M.D., and his colleagues at the University of Michigan, the incidence of herpes zoster ophthalmicus (HZO)—shingles of the eye—had tripled in the United States from 2004 to 2016.

In this JAMA article published on August 7, 2019, one of the leading reasons behind this increase is millions of older adults have waning cell-mediated immunity that leaves them vulnerable to reactivation of varicella virus, which causes shingles.

Dr. Shekhawat’s study data of 21 million adults enrolled in insurance plans, showed that older age is also a risk factor for HZO.

In addition to age as a risk factor, his data also suggested that women were more likely than men to develop HZO, as were white adults compared with black, Asian, and Latino adults—the same demographic patterns as with shingles.

This finding of increased HZO incidence persisted when adjusted for age, race, and sex, raising some important questions.

Complications from HZO, in which the varicella virus reactivates in the ophthalmic division of the trigeminal nerve, can be severe. The virus may cause pronounced eyelid edema or skin lesions around the eye.

Ocular zoster can affect any part of the eye from the conjunctiva to the optic nerve. It can cause keratitis, scleritis, uveitis, trabeculitis, choroiditis, acute retinal necrosis, optic neuritis, nerve palsies, and cavernous sinus thrombosis.

Other complications include glaucoma, retinal necrosis, and blindness, as well as an increased risk of stroke.

The initial symptom is hyperesthesia or paresthesia, which may be severe, along the affected dermatome. This is followed by a maculopapular rash that becomes vesicular and finally pustular before crusting.

Some 20 percent of people with shingles will develop HZO, said Dr. Shekhawat, who presented his data in May 2019, at the Association for Research in Vision and Ophthalmology annual meeting.

Dr. Shekhawat contends that the booster-theory is still in play.

“People are not getting that periodic immune boost against the varicella-zoster virus that they may have been getting in prior years because they don’t get exposed to their kids getting chickenpox anymore.”

Furthermore, Albert van Hoek, Ph.D., of the London School of Hygiene and Tropical Medicine in the United Kingdom, suggested that the increases are likely due to several simultaneous phenomena, including reduced immune boosting.

van Hoek noted that because US fertility and mortality rates were declining long before varicella vaccination began, the proportion of children in the population decreased and fewer adults got an immune boost from exposure to kids with chickenpox.

van Hoek also cited a study showing that the incidence of shingles among adults living with children was lower than in adults without frequent exposure to children.

“The other possibility is that the health status of the overall population has changed,” Dr. Shekhawat said.

More people may be at greater risk of shingles because they’re immunosuppressed from cancer chemotherapy, HIV/AIDS, treatment for autoimmune diseases, or diabetes, he noted.

For now, however, that remains a theory.

According to the CDC, the reason for the HZO increases isn’t known.

In October 2017, the Advisory Committee on Immunization Practices (ACIP) of the CDC issued a recommendation for use of a new shingles vaccine called Shingrix a recombinant zoster vaccine.

This vaccine is recommended for adults aged 50 years or older. Based on current data, the recombinant zoster vaccine appears to be more effective than the older vaccine, reducing the risk of both shingles and postherpetic neuralgia by about 90% in adults aged 50 years or older.

Shingrix is not a live vaccine and should be safer than the older vaccine for people with weakened immune systems.

For those who aren’t able to receive Shingrix, ACIP recommends Zostavax for immunocompetent adults aged 60 years or older.

These researchers did not disclose any conflicts of interest with this study.

Sub Title:

Herpes zoster ophthalmicus (HZO) occurs when the varicella virus reactivates in the ophthalmic division of the trigeminal nerve

References:

Shingles Vaccination

Herpes Zoster Ophthalmicus

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John Paul Sanchez, PharmD

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Shingrix Vaccine Reported Very Effective With Stem Cell Patients

Don Hackett — Tue, 09 Jul 2019 19:27:44 +0000

Reviewer:

Kelley Lu, PharmD

Effect of Recombinant Zoster Vaccine on Incidence of Herpes Zoster After Autologous Stem Cell Transplantation

The non-live herpes zoster vaccine Shingrix was found to reduce the occurrence of herpes zoster (shingles) among patients who had undergone stem-cell transplantation with their own stem cells.

This phase 3 clinical trial published in JAMA on July 9, 2019, found a 2-dose course of Shringrix vaccine compared with placebo, significantly reduced the incidence of herpes zoster over a median follow-up of 21 months.

This is important news since the risk for a case of shingles increases after this type of stem-cell transplantation, said these Duke University researchers in a press release on July 9, 2019.

Additionally, a preventive shingles vaccine that contains a weakened live strain of the shingles virus isn't recommended for these immunocompromised patients.

This study was conducted in 28 countries including 1,846 patients who had undergone stem cell transplantation. During a follow-up of about 21 months, an incidence of 30 cases per 1000 person-years after 2 doses of the vaccine was compared with 94 per 1000 person-years after placebo.

This difference was reported to be statistically significant by these researchers.

Shingles vaccination is the only way to protect against shingles and postherpetic neuralgia (PHN), the most common complication from shingles, says the Centers for Disease Control and Prevention (CDC).

The CDC recommends that healthy adults 50 years and older get 2 doses of the shingles vaccine called Shingrix, separated by 2 to 6 months, to prevent shingles and the complications from the disease.

Two doses of Shingrix is more than 90 percent effective at preventing shingles and PHN.

Protection stays above 85 percent for at least the first 4 years after you get vaccinated, says the CDC.

Shingles vaccine news

Shingrix is the preferred vaccine, over Zostavax which is a live zoster vaccine, a shingles vaccine in use since 2006.

Zostavax may still be used to prevent shingles in healthy adults 60 years and older, says the CDC.

For example, you could use Zostavax if a person is allergic to Shingrix, prefers Zostavax, or requests immediate vaccination and Shingrix is unavailable.

Sub Title:

GSK Herpes Zoster Vaccine Shingrix reduced the incidence of herpes zoster in autologous stem cell transplant recipients

References:

Study to Evaluate Efficacy, Safety, and Immunogenicity of GlaxoSmithKline (GSK) Biologicals' Herpes Zoster Vaccine GSK1437173A

New shingles vaccine reduced occurrence in patients who had stem cell transplantation

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2-Doses of Varicella Vaccine Works Best For Children

Don Hackett — Mon, 10 Jun 2019 13:04:07 +0000

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