title: Effectiveness and Duration of Protection Provided by the Live-attenuated Herpes Zoster Vaccine in the Medicare Population Ages 65 Years and Older.
abstract: Tens of millions of seniors are at risk of herpes zoster (HZ) and its complications. Live attenuated herpes zoster vaccine (HZV) reduces that risk, although questions regarding effectiveness and durability of protection in routine clinical practice remain. We used Medicare data to investigate HZV effectiveness (VE) and its durability.
  
  
  
  This retrospective cohort study included beneficiaries ages ≥65 years during January 2007 through July 2014. Multiple adjustments to account for potential bias were made. HZV-vaccinated beneficiaries were matched to unvaccinated beneficiaries (primary analysis) and to HZV-unvaccinated beneficiaries who had received pneumococcal vaccination (secondary analysis). HZ outcomes in community and hospital settings were analyzed, including ophthalmic zoster (OZ) and postherpetic neuralgia (PHN).
  
  
  
  Among eligible beneficiaries (average age 77 years), the primary analysis found VE for community HZ of 33% (95% CI: 32%-35%) and 19% (95% CI: 17%-22%), for the first 3, and subsequent 4+ years postvaccination, respectively. In the secondary analysis, VE was, respectively, 37% (95% CI: 36%-39%) and 22% (95% CI: 20%-25%). In the primary analysis, VE for PHN was 57% (95% CI: 52%-61%) and 45% (95% CI: 36%-53%) in the first 3 and subsequent 4+ years, respectively; VE for hospitalized HZ was, respectively, 74% (95% CI: 67%-79%) and 55% (95% CI: 39%-67%). Differences in VE by age group were not significant.
  
  
  
  In both the primary and secondary analyses, HZV provided protection against HZ across all ages, but effectiveness declined over time. VE was higher and better preserved over time for PHN and HZ-associated hospitalizations than for community HZ.
authors.affiliation: Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA.|Universidad Rey Juan Carlos, Madrid, Spain.
authors.forename: Hector S
authors.initials: HS
authors.lastname: Izurieta
authors.affiliation: Acumen LLC, Burlingame, California, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Wernecke
authors.affiliation: Centers for Medicare and Medicaid Services, Washington, DC, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kelman
authors.affiliation: Acumen LLC, Burlingame, California, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Wong
authors.affiliation: Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Forshee
authors.affiliation: Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Pratt
authors.affiliation: Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA.
authors.forename: Yun
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Acumen LLC, Burlingame, California, USA.
authors.forename: Qin
authors.initials: Q
authors.lastname: Sun
authors.affiliation: Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Jankosky
authors.affiliation: Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Krause
authors.affiliation: Centers for Medicare and Medicaid Services, Washington, DC, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Worrall
authors.affiliation: Acumen LLC, Burlingame, California, USA.
authors.forename: Tom
authors.initials: T
authors.lastname: MaCurdy
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Harpaz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006562:Herpes Zoster / Q000453:epidemiology* / Q000517:prevention & control*; D053061:Herpes Zoster Vaccine / Q000276:immunology*; D014645:Herpesvirus 3, Human / Q000276:immunology*; D006801:Humans; D008297:Male; D006278:Medicare; D017063:Outcome Assessment, Health Care; D014481:United States / Q000453:epidemiology / Q000208:ethnology; D014611:Vaccination; D014613:Vaccines, Attenuated / Q000276:immunology*
chemical_list: D053061:Herpes Zoster Vaccine; D014613:Vaccines, Attenuated
keywords: Herpes Zoster vaccine; elderly; opthalmic zoster; post-herpetic neuralgia; vaccine effectiveness