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Immunisation for herpes zoster: current status

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Herpes zoster is a painful, disabling condition so the recent development of preventive vaccines is welcome

Herpes zoster, or shingles, can occur at virtually any age but is most common after the age of 50 years, and carries a lifetime risk of up to 50% in people living for 85 years or more. The incidence is about 3–4 per 1000 of the general Australian population, rising to about 10 per 1000 in those aged over 60 years and similar in other OECD countries.1,2 Herpes zoster is caused by the reactivation of the varicella zoster virus in the nerve cells of the dorsal root ganglion adjacent to the spinal cord.3 This reactivation occurs through waning of T cell immunity, also consistent with the increased incidence and severity in immunocompromised patients. However, the exact threshold and nature of T cell immunity required to prevent varicella viral reactivation is still unclear. This T cell immunity may be boosted by encounters with patients with chicken pox. Early studies showed promise in using live attenuated varicella vaccine to boost T cell immunity and prevent herpes zoster.4

A double-blind placebo-controlled shingles prevention study (SPS) was undertaken with a (14-fold) concentrated form of the live attenuated varicella (Oka strain) vaccine administered…