Preventing shingles in older adults: how effective and safe is vaccination? A new Cochrane review

Key Message:Herpes zoster vaccine is effective in preventing shingles, with people aged 60 to 69 years benefitting more than older people but also experiencing more side effects. In general, the vaccine is well tolerated and most side effects are mild to moderate reactions at the injection site.

Herpes zoster or ‘shingles’ is a painful condition, arising from the reactivation of varicella zoster virus, the virus that causes chicken pox. Older adults are particularly susceptible to shingles, which can last for weeks or months and have a significant impact on quality of life. A new review from the Cochrane Acute Respiratory Infections Group evaluated the effectiveness and safety of vaccination to prevent herpes zoster in adults aged sixty and over. The review includes eight randomized controlled trials with more than 52,000 participants but the main outcomes on effectiveness and safety come from the Shingles Prevention Study, a large trial with 38,546 participants, who were followed up for over three years.

What did they find?

  • Confirmed cases of shingles were less frequent in people who had received the vaccine than in those who received a placebo
  • The vaccine was more effective in people aged 60 to 69 years, but individuals in this age group were also more susceptible to adverse effects compared to those 70 years or over
  • Injection site reactions were more common in people receiving frozen vaccine than in those given a refrigerated vaccine; there were no differences in other adverse effects
  • No significant difference was found between groups in pain-related interference in daily life in the Shingles Prevention Study, the only trial which explored this

How good is the evidence?

Study quality was mixed but the large trial which provided the data for the main outcomes was judged to be at low risk of bias.

Links:

Gagliardi AMZ, Gomes Silva BN, Torloni MR, Soares BGO. Vaccines for preventing herpes zoster in older adults. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD008858. DOI: 10.1002/14651858.CD008858.pub2.

Cochrane summary and podcast http://summaries.cochrane.org/CD008858/vaccines-for-preventing-herpes-zoster-in-older-adults

This review is featured on The Cochrane Collaboration website:  Vaccines for preventing herpes zoster (‘shingles’) in older adults. http://www.cochrane.org/features/vaccines-preventing-herpes-zoster-%E2%80%98shingles%E2%80%99-older-adults

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Sarah Chapman

About Sarah Chapman

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Sarah's work as a Knowledge Broker at Cochrane UK focuses on disseminating Cochrane evidence through social media, including Evidently Cochrane blogs, blogshots and the ‘Evidence for Everyday’ series for nurses, midwives, allied health professionals and patients. A former registered general nurse, Sarah has a particular interest making evidence accessible and useful to practitioners and to others making decisions about health. Before joining Cochrane, Sarah also worked on systematic reviews for the University of Oxford and the Royal College of Nursing Institute, and obtained degrees in History from the University of Oxford and in the history of women’s health and illness in early modern England (MPhil., University of Reading).

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