title: Zoster Vaccine and the Risk of Postherpetic Neuralgia in Patients Who Developed Herpes Zoster Despite Having Received the Zoster Vaccine.
abstract: BACKGROUND
  Although it is evident that zoster vaccination reduces postherpetic neuralgia (PHN) risk by reducing herpes zoster (HZ) occurrence, it is less clear whether the vaccine protects against PHN among patients who develop HZ despite previous vaccination.
  
  
  METHODS
  This cohort study included immunocompetent patients with HZ. The vaccinated cohort included 1155 individuals who were vaccinated against HZ at age ≥60 years and had an HZ episode after vaccination. Vaccinated patients were matched 1:1 by sex and age with unvaccinated patients. Trained medical residents reviewed the full medical record to determine the presence of HZ-related pain at 1, 2, 3, and 6 months after HZ diagnosis. The incidence of PHN was compared between vaccinated and unvaccinated -patients.
  
  
  RESULTS
  Thirty vaccinated women (4.2%) experienced PHN, compared with 75 unvaccinated women (10.4%), with an adjusted relative risk of 0.41 (95% confidence interval, .26-.64). PHN occurred in 26 vaccinated men (6.0%) versus 25 unvaccinated men (5.8%), with an adjusted relative risk of 1.06 (.58-1.94). These associations did not differ significantly by age.
  
  
  CONCLUSIONS
  Among persons experiencing HZ, prior HZ vaccination is associated with a lower risk of PHN in women but not in men. This sex-related difference may reflect differences in healthcare-seeking patterns and deserve further investigation.
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Hung Fu
authors.initials: HF
authors.lastname: Tseng
authors.affiliation: Departments of Family Medicine.
authors.forename: Bruno
authors.initials: B
authors.lastname: Lewin
authors.affiliation: Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Hales
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Lina S
authors.initials: LS
authors.lastname: Sy
authors.affiliation: Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Rafael
authors.initials: R
authors.lastname: Harpaz
authors.affiliation: Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Bialek
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Yi
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Jacobsen
authors.affiliation: Internal Medicine, Kaiser Permanente Southern California, Los Angeles Medical Center.
authors.forename: Kavya
authors.initials: K
authors.lastname: Reddy
authors.affiliation: Departments of Family Medicine.
authors.forename: Po-Yin
authors.initials: PY
authors.lastname: Huang
authors.affiliation: Internal Medicine, Kaiser Permanente Southern California, Los Angeles Medical Center.
authors.forename: Jeff
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Sean
authors.initials: S
authors.lastname: Anand
authors.affiliation: Internal Medicine, Kaiser Permanente Southern California, Los Angeles Medical Center.
authors.forename: Erin Mary
authors.initials: EM
authors.lastname: Bauer
authors.affiliation: Departments of Family Medicine.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chang
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Sara Y
authors.initials: SY
authors.lastname: Tartof
mesh_terms: D000368:Aged; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006562:Herpes Zoster / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D053061:Herpes Zoster Vaccine / Q000276:immunology*; D014645:Herpesvirus 3, Human / Q000276:immunology*; D006801:Humans; D007121:Immunocompetence; D015994:Incidence; D008297:Male; D008875:Middle Aged; D051474:Neuralgia, Postherpetic / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D012306:Risk; D014611:Vaccination
chemical_list: D053061:Herpes Zoster Vaccine
keywords: adult vaccination; herpes zoster; post-herpetic neuralgia; shingles; varicella zoster virus