BACKGROUND AND PURPOSE:

• In clinical trials, the recombinant herpes zoster vaccine (RZV) has demonstrated efficacy in preventing postherpetic neuralgia (PHN) but data on protection against herpes zoster ophthalmicus (HZO) is limited
• Zerbo et al. (JAMA Network Open, 2025) investigated whether RZV is associated with a reduction in the risk of PHN and HZO

METHODS:

• Cohort study
  • 4 health plans in the Vaccine Safety Datalink
  • Between January 1, 2018, to December 31, 2022
• Population
  • Adults aged ≥50
• Exposures
  • Vaccination status
    • Partially vaccinated: ≥30 days from first dose but no second dose
    • Fully vaccinated: ≥30 days from second dose
    • Unvaccinated
• Study design
  • Cox regression was used to estimate hazard ratios
  • Vaccine effectiveness (VE) was estimated as 1 minus the HR, scaled as a percentage
• Primary outcome
  • VE against PHN and HZO

RESULTS:

• 1,999,885 individuals
  • Aged 50 to 69: 74.5% | Aged >70: 25.5%
  • Male: 46.6%
  • Fully vaccinated: 28.8% | Partially vaccinated: 9.3%
  • Had herpes zoster: 2.3%
• VE against PHN
  • Fully vaccinated: 87% (95% CI, 83 to 90)
  • Partially vaccinated: 69% (95% CI, 59 to 76)
• VE against HZO
  • Fully vaccinated: 78% (95% CI, 73 to 82)
  • Partially vaccinated: 68% (95% CI, 58 to 76)
• VE waned slightly after 2 years, but still remained above 74% for both outcomes

CONCLUSION:

• Two doses of RZV was effective at reducing the risk of both postherpetic neuralgia and herpes zoster ophthalmicus
• The authors state

This study was limited by its case finding, which missed persons with PHN or HZO who did not seek care

Nonetheless, in this large cohort, we found RZV to be associated with reducing the risk PHN and HZO

Learn More – Primary Sources:

Recombinant Zoster Vaccination and Risk of Postherpetic Neuralgia or Zoster Ophthalmicus