Varicella-zoster virus-specific immune responses to herpes zoster in elderly participants in a trial of a clinically effective zoster vaccine.
BACKGROUND
The objectives of this study were to evaluate the association between varicella-zoster virus (VZV)-specific humoral and cell-mediated immunity (CMI) to herpes zoster (HZ) and protection against HZ morbidity and to compare immune responses to HZ and zoster vaccine.


METHODS
In 981 elderly persons who developed HZ during a zoster vaccine efficacy trial (321 vaccinees and 660 placebo recipients) and 1362 without HZ (682 vaccinees and 680 placebo recipients), CMI was measured by VZV responder cell frequency and interferon-gamma enzyme-linked immunospot, and antibodies were measured by VZV enzyme-linked immunosorbent assay against affinity-purified VZV glycoproteins (gpELISA).


RESULTS
Robust VZV CMI at HZ onset correlated with reduced HZ morbidity, whereas VZV gpELISA titers did not. Three weeks after HZ onset, gpELISA titers were highest in those with more severe HZ and were slightly increased in placebo recipients (compared with zoster vaccine recipients) and in older individuals. VZV CMI responses to HZ were similar in zoster vaccine and placebo recipients and were not affected by demographic characteristics or antiviral therapy, except for responder cell frequency at HZ onset, which decreased with age. When responses to zoster vaccine and HZ could be compared, VZV CMI values were similar, but antibody titers were lower.


CONCLUSIONS
Higher VZV CMI at HZ onset was associated with reduced HZ severity and less postherpetic neuralgia. Higher antibody titers were associated with increased HZ severity and occurrence of postherpetic neuralgia. HZ and zoster vaccine generated comparable VZV CMI.
Weinberg
Adriana
A
University of Colorado Denver, Denver, CO, USA. Adriana.Weinberg@ucdenver.edu
Zhang
Jane H
JH
Oxman
Michael N
MN
Johnson
Gary R
GR
Hayward
Anthony R
AR
Caulfield
Michael J
MJ
Irwin
Michael R
MR
Clair
James
J
Smith
Jeffrey G
JG
Stanley
Harold
H
Marchese
Rocio D
RD
Harbecke
Ruth
R
Williams
Heather M
HM
Chan
Ivan S F
IS
Arbeit
Robert D
RD
Gershon
Anne A
AA
Schödel
Florian
F
Morrison
Vicki A
VA
Kauffman
Carol A
CA
Straus
Steve E
SE
Schmader
Kenneth E
KE
Davis
Larry E
LE
Levin
Myron J
MJ
D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006562:Herpes Zoster / Q000276:immunology / Q000517:prevention & control*; D014645:Herpesvirus 3, Human / Q000276:immunology*; D006801:Humans; D007111:Immunity, Cellular; D008297:Male; D008875:Middle Aged; D051474:Neuralgia, Postherpetic / Q000517:prevention & control; D013997:Time Factors; D014765:Viral Vaccines / Q000276:immunology*
D000914:Antibodies, Viral; D014765:Viral Vaccines