Resident’s Forum
Vaccine for the Prevention of Herpes Zoster
FR-Nueva vacuna recombinante para la prevención del herpes zóster
D. Morgado-Carrasco
, X. Fustà-Novell, P. Giavedoni
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Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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Morgado-Carrasco, X. Fustà-Novell, P. Giavedoni" "autores" => array:3 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Morgado-Carrasco" "email" => array:1 [ 0 => "morgado@clinic.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "X." "apellidos" => "Fustà-Novell" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Giavedoni" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR-Nueva vacuna recombinante para la prevención del herpes zóster" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Herpes zoster is caused by reactivation of the varicella zoster virus, which is characterized by a generally localized and painful vesicular skin rash. Its incidence has increased in recent decades. The most frequent complication is postherpetic neuralgia, which affects around 18% of patients with herpes zoster and may cause disabling pain. The incidence of both conditions clearly increases with age. Postherpetic neuralgia affects more than 30% of persons with herpes zoster aged >79 years. The attenuated varicella zoster virus vaccine (aVZV) has an efficacy of 51% for prevention of herpes zoster; this efficacy decreases with age. The vaccine is contraindicated in immunocompromised patients and approved by the United States Food and Drug Administration (FDA) for this indication in immunocompetent patients aged ≥50 years.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The FDA recently approved a new recombinant vaccine for treatment of herpes zoster (rVZV) (Shingrix, GlaxoSmithKline). rVZV contains recombinant glycoprotein E of the varicella zoster virus, together with the adjuvant AS01<span class="elsevierStyleInf">B</span>, and is administered in 2 subcutaneous injections separated by 2–6 months (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The efficacy of rVZV was evaluated in 2 phase 3 randomized, placebo-controlled clinical trials (ZOE-50<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and ZOE-70<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>). Median follow-up was longer than 3 years in both trials. ZOE-50 included 15 411 patients aged ≥50 years and reported 6 cases of herpes zoster in the vaccinated group compared with 210 in the placebo group. Overall efficacy in the prevention of herpes zoster was 97.2% (95% CI, 93.7–99.0%; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> ZOE-70 included 13 900 patients aged ≥70 years. Efficacy was 89.8% (95% CI, 84.2–93.7%; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001) for prevention of herpes zoster and 88.8% (95% CI, 68.7–97.1%; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001) for prevention of postherpetic neuralgia.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> A pooled analysis of both studies showed that efficacy was 93.7% (95% CI, 59.5–99.9%) for the prevention of post–herpes zoster complications other than postherpetic neuralgia, i.e., disseminated herpes zoster, secondary vasculitis, encephalic vascular accident, and ophthalmic, neurologic, and visceral disease.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In both studies, the frequency of adverse events was similar in the vaccination and placebo groups. The most frequent adverse events were injection site pain, myalgia, and fatigue.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">rVZV has proven more successful than aVZV for prevention of herpes zoster and postherpetic neuralgia. Furthermore, the cost-effectiveness analysis favored rVZV over aVZV.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Consequently, the Advisory Committee on Immunization Practices in the United States recently recommended rVZV for immunocompetent patients aged ≥50 years, even in those previously vaccinated with aVZV and those who have had herpes zoster.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Evidence remains insufficient to recommend rVZV in immunocompetent patients or patients who are receiving immunosuppressive treatment with prednisone ≥20 mg/d, although it could, in theory, be administered.</p><p id="par0020" class="elsevierStylePara elsevierViewall">rVZV is an efficacious and safe alternative for prevention of herpes zoster and postherpetic neuralgia and should be recommended in adults. It could thus help to reduce the morbidity associated with these conditions.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-05-18" "fechaAceptado" => "2018-06-25" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1223716" "palabras" => array:6 [ 0 => "Herpes zoster vaccine" 1 => "Recombinant vaccine" 2 => "Adyuvanted" 3 => "Herpes zoster" 4 => "Post herpetic neuralgia" 5 => "Shingrix®" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Morgado-Carrasco D, Fustà-Novell X, Giavedoni P. FR-Nueva vacuna recombinante para la prevención del herpes zóster. Actas Dermosifiliogr. 2020;111:67–68.</p>" ] ] "multimedia" => array:1 [ 0 => array:9 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Dooling et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>" "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: HZ, herpes zoster; HZ/su, HZ/subunit; aVZV, attenuated varicella zoster vaccine.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Composition \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Administration \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Target Patients \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Special Situations \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Coadministration \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Recombinant glycoprotein E of varicella zoster virus, which is essential for viral replication and propagation and is the target of the specific immune response. Adjuvant AS01<span class="elsevierStyleInf">B</span> (HZ/su), which promotes a marked and prolonged CD4 response to recombinant proteins. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Two subcutaneous injections separated by 2–6<span class="elsevierStyleHsp" style=""></span>mo. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adults aged ≥50 y, even if they have been previously vaccinated with aVZV or affected by HZ. Serological screening for varicella is not recommended. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not currently recommended for pregnant women. Patients with chronic diseases (chronic kidney failure, diabetes mellitus, chronic lung disease) should be vaccinated. Patients experiencing an acute episode of HZ should not be vaccinated until resolution of the acute phase. Patients receiving prednisone <20<span class="elsevierStyleHsp" style=""></span>mg/d should be vaccinated. Immunocompromised patients or patients receiving prednisone ≥20<span class="elsevierStyleHsp" style=""></span>mg/d should not be vaccinated<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Can be coadministered with other vaccines in adults. Should be injected at different sites. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2275671.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Evidence remains insufficient to recommend vaccination in immunocompetent patients, although it is possible in theory.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Characteristics and Indications of the Recombinant Herpes Zoster Vaccine (Shingrix).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. 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Belongia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.15585/mmwr.mm6703a5" "Revista" => array:6 [ "tituloSerie" => "MMWR Morb Mortal Wkly Rep" "fecha" => "2018" "volumen" => "67" "paginaInicial" => "103" "paginaFinal" => "108" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29370152" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011100000001/v2_202004200619/S1578219019303506/v2_202004200619/en/main.assets" "Apartado" => array:4 [ "identificador" => "34945" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Resident's Forum" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011100000001/v2_202004200619/S1578219019303506/v2_202004200619/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019303506?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 8 | 6 | 14 |
| 2024 Octubre | 105 | 50 | 155 |
| 2024 Septiembre | 89 | 31 | 120 |
| 2024 Agosto | 135 | 57 | 192 |
| 2024 Julio | 109 | 32 | 141 |
| 2024 Junio | 103 | 67 | 170 |
| 2024 Mayo | 111 | 41 | 152 |
| 2024 Abril | 131 | 27 | 158 |
| 2024 Marzo | 111 | 32 | 143 |
| 2024 Febrero | 95 | 32 | 127 |
| 2024 Enero | 95 | 32 | 127 |
| 2023 Diciembre | 75 | 17 | 92 |
| 2023 Noviembre | 111 | 27 | 138 |
| 2023 Octubre | 67 | 21 | 88 |
| 2023 Septiembre | 78 | 29 | 107 |
| 2023 Agosto | 44 | 20 | 64 |
| 2023 Julio | 65 | 31 | 96 |
| 2023 Junio | 73 | 22 | 95 |
| 2023 Mayo | 68 | 30 | 98 |
| 2023 Abril | 56 | 18 | 74 |
| 2023 Marzo | 66 | 26 | 92 |
| 2023 Febrero | 41 | 20 | 61 |
| 2023 Enero | 47 | 27 | 74 |
| 2022 Diciembre | 42 | 34 | 76 |
| 2022 Noviembre | 40 | 27 | 67 |
| 2022 Octubre | 33 | 22 | 55 |
| 2022 Septiembre | 24 | 38 | 62 |
| 2022 Agosto | 56 | 35 | 91 |
| 2022 Julio | 40 | 47 | 87 |
| 2022 Junio | 42 | 28 | 70 |
| 2022 Mayo | 32 | 36 | 68 |
| 2022 Abril | 37 | 30 | 67 |
| 2022 Marzo | 42 | 51 | 93 |
| 2022 Febrero | 45 | 38 | 83 |
| 2022 Enero | 26 | 33 | 59 |
| 2021 Diciembre | 23 | 40 | 63 |
| 2021 Noviembre | 40 | 46 | 86 |
| 2021 Octubre | 44 | 60 | 104 |
| 2021 Septiembre | 44 | 45 | 89 |
| 2021 Agosto | 26 | 30 | 56 |
| 2021 Julio | 30 | 23 | 53 |
| 2021 Junio | 40 | 19 | 59 |
| 2021 Mayo | 44 | 31 | 75 |
| 2021 Abril | 64 | 64 | 128 |
| 2021 Marzo | 48 | 26 | 74 |
| 2021 Febrero | 40 | 21 | 61 |
| 2021 Enero | 33 | 21 | 54 |
| 2020 Diciembre | 27 | 29 | 56 |
| 2020 Noviembre | 31 | 22 | 53 |
| 2020 Octubre | 25 | 16 | 41 |
| 2020 Septiembre | 28 | 15 | 43 |
| 2020 Agosto | 39 | 19 | 58 |
| 2020 Julio | 20 | 13 | 33 |
| 2020 Junio | 21 | 20 | 41 |
| 2020 Mayo | 37 | 19 | 56 |
| 2020 Abril | 46 | 24 | 70 |
| 2020 Marzo | 21 | 9 | 30 |
| 2020 Febrero | 2 | 0 | 2 |
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