title: The herpes zoster subunit vaccine.
abstract: BACKGROUND
  Herpes zoster (HZ) causes severe pain and rash in older people and may be complicated by prolonged pain (postherpetic neuralgia; PHN).
  
  
  METHODS
  HZ results from reactivation of latent varicella-zoster virus (VZV) infection, often associated with age related or other causes of decreased T cell immunity. A concentrated live attenuated vaccine boosts this immunity and provides partial protection against HZ, but this decreases with age and declines over 5-8 years. The new HZ subunit (HZ/su or Shingrix) vaccine combines a key surface VZV glycoprotein (E) with T cell boosting adjuvant (AS01B). It is highly efficacious in protection (97%) against HZ in immunocompetent subjects, with no decline in advancing age and protection maintained for >3 years. Phase I-II trials showed safety and similar immunogenicity in severely immunocompromised patients. Local injection site pain and swelling can be severe in a minority (9.5%) but is transient (2 days).
  
  
  CONCLUSIONS
  The HZ/su vaccine appears very promising in immunocompetent patients in the ZoE-50 controlled trial. The unblinding of the current ZoE-50 trial and publication of results from the accompanying ZoE-70 trial will reveal more about its mechanism of action and its efficacy against PHN, particularly in subjects >70 years. Phase III trial results in immunocompromised patients are eagerly awaited.
authors: a Centre for Virus Research , The Westmead Institute for Medical Research, University of Sydney , Westmead , New South Wales , Australia.
authors: Anthony L
authors: AL
authors: Cunningham
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000818:Animals; D006562:Herpes Zoster / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control*; D053061:Herpes Zoster Vaccine / Q000627:therapeutic use*; D014645:Herpesvirus 3, Human / Q000276:immunology; D006801:Humans; D007121:Immunocompetence / Q000276:immunology; D051474:Neuralgia, Postherpetic / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control; D014613:Vaccines, Attenuated / Q000627:therapeutic use; D022223:Vaccines, Subunit / Q000627:therapeutic use
chemical_list: D000276:Adjuvants, Immunologic; D053061:Herpes Zoster Vaccine; D014613:Vaccines, Attenuated; D022223:Vaccines, Subunit
keywords: HZ/su vaccine; Herpes zoster; postherpetic neuralgia; vaccine