ATAGI Targeted Review 2022: Vaccination for prevention of herpes zoster in Australia

Authors

  • Yuanfei Anny Huang National Centre for Immunisation Research and Surveillance, Children’s Hospital at Westmead, Sydney, New South Wales, Australia
  • Jean Li-Kim-Moy National Centre for Immunisation Research and Surveillance, Children’s Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  • Sanjay Jayasinghe National Centre for Immunisation Research and Surveillance, Children’s Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  • Clayton Chiu National Centre for Immunisation Research and Surveillance, Children’s Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  • Kristine Macartney National Centre for Immunisation Research and Surveillance, Children’s Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia
  • Bette Liu National Centre for Immunisation Research and Surveillance, Children’s Hospital at Westmead, Sydney, New South Wales, Australia; Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia; School of Population Health, University of New South Wales, Sydney, Australia
  • Penelope Burns Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia; College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia; Department of General Practice, School of Medicine, Western Sydney University, Sydney, Australia
  • Michelle Giles Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases, University of Melbourne, Melbourne, Victoria, Australia
  • Nigel Crawford Australian Technical Advisory Group on Immunisation, Department of Health, Australian Government, Canberra, Australian Capital Territory, Australia; Immunisation Services, Royal Children’s Hospital, Melbourne, Victoria, Australia; Infection and Immunity, Murdoch Children’s Research Institute and Department of Paediatrics, University of Melbourne, Victoria, Australia

DOI:

https://doi.org/10.33321/cdi.2023.47.21

Keywords:

Herpes zoster, herpes zoster vaccine

Abstract

This Review was updated on 3 May 2023 to include an Acknowledgments section omitted from the original text.

In November 2016, herpes zoster (HZ) vaccination for older adults, using the live-attenuated zoster vaccine (Zostavax; ZVL) was added to the Australian National Immunisation Program (NIP) with the aim of reducing morbidity from HZ and its complications, particularly for people at increased risk. Prior to the program, there were on average 5.6 cases of HZ per 1,000 persons annually in Australia, with highest risk of disease in older and in immunocompromised people. The burden of complications of HZ, such as post-herpetic neuralgia (PHN), was also highest in older and immunocompromised groups.
No formal comprehensive program evaluation has been undertaken since program commencement. This review examined published literature and available vaccine administration data to summarise the evidence and considerations underpinning current use of HZ vaccines and potential future program directions in Australia.
There have been modest reductions in the incidence of HZ and its complications since program introduction. However, five years into the program, challenges remain, including suboptimal vaccine coverage and significant safety concerns arising from inadvertent use of ZVL in immunocompromised people, who are contraindicated to receive this vaccine. This reduces opportunities to offset the burden of HZ-related disease.
The recombinant subunit zoster vaccine (Shingrix; RZV), first registered in Australia in 2018, became available on the Australian market in June 2021. This vaccine has higher efficacy than ZVL and, as a non-live vaccine, can be used in both immunocompetent and immunocompromised people. RZV has potential to address the unmet needs of at-risk population groups. However, it has not yet demonstrated cost-effectiveness for inclusion as a funded vaccine under the NIP.
The Australian HZ vaccination program has had limited effectiveness in meeting its aim in highest risk groups. Future options and challenges anticipated in using vaccination to reduce the burden of HZ and its complications are discussed in this review.

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Published

27/04/23

How to Cite

Huang, Yuanfei Anny, Jean Li-Kim-Moy, Sanjay Jayasinghe, Clayton Chiu, Kristine Macartney, Bette Liu, Penelope Burns, Michelle Giles, and Nigel Crawford. 2023. “ATAGI Targeted Review 2022: Vaccination for Prevention of Herpes Zoster in Australia”. Communicable Diseases Intelligence 47 (April). https://doi.org/10.33321/cdi.2023.47.21.

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