Live-Attenuated Zoster Vaccine Reduces Herpes Zoster Pain and Neuralgia

Live-attenuated herpes zoster vaccine protects against postherpetic neuralgia even when [herpes zoster] occurs despite vaccination.

Live-attenuated zoster vaccine has demonstrated efficacy in reducing pain related to herpes zoster, as well as preventing both herpes zoster and postherpetic neuralgia, according to a study recently published in Vaccine.

This study included 1018 individuals with herpes zoster, 509 of whom were vaccinated and 509 of whom were not. All participants were at least 60 years of age and older and were diagnosed between January 2012 and February 2015. Following diagnosis of herpes zoster, follow-up was performed within 5 days and at days 30, 60, and 90. During the baseline interview, ≥2 skin lesion samples were collected for a standard polymerase chain reaction test.

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Those with negative results were not included in the study. The Zoster Brief Pain Inventory was used to assess pain on a scale from 0 to 10, with threshold points of ≥3, ≥5, and ≥7 and postherpetic neuralgia assigned at pain ≥3 at 90 days. Risk ratios were estimated using log binomial regression and compared between those with and without vaccinations.

Those with zoster vaccine live vaccination were less likely than those without to have herpes zoster-related pain, particularly at later time points; at 90 days, the risk for worst pain ≥3 points was 9.2% among those with vaccinations and 15.4% in those without (adjusted risk ratio, 0.594 [95% CI, 0.413-0.854]). At 90 days, the risk for worst pain ≥7 points was 2.0% among vaccinated patients and 4.8% among unvaccinated patients (adjusted risk ratio, 0.332 [95% CI, 0.153-0.721]).

Postherpetic neuralgia was more likely among adults at least 70 years of age and older compared with those younger than age 70 and among those who were unvaccinated compared with those who were vaccinated (younger than 70 years old, 11.1% vs 4.6% in unvaccinated vs vaccinated individuals, respectively; at least 70 years of age and older, 17.6% vs 11.2% in unvaccinated vs vaccinated individuals, respectively).

Limitations to this study include potential participation bias, a potential lack of recognition of associated factors linked to receipt of zoster vaccine live, a portion of the population who did not respond to at least one interview attempt, and small sample sizes among some subgroups.

The study researchers conclude that “this study describes follow up of laboratory-confirmed [herpes zoster] cases and provides evidence that [zoster vaccine live] protects against [postherpetic neuralgia] even when [herpes zoster] occurs despite vaccination. Our study also provides insights on the natural history of [herpes zoster] and demonstrates that survey data relating to chronic pain can differ considerably from [electronic health records]-encounter data, even in the same health care settings — a methodological issue that can benefit from further analysis. As [recombinant zoster vaccine] is increasingly used over [zoster vaccine live], it will be imperative to evaluate the incremental benefit of [recombinant zoster vaccine] in preventing [herpes zoster]-related pain.”

Several authors report financial associations with pharmaceutical companies. For a complete list of disclosures, visit the reference.


Bruxvoort KJ, Liang AS, Harpaz R, et al. Patient report of herpes zoster pain: incremental benefits of zoster vaccine live [published online May 11, 2019]. Vaccine. doi: 10.1016/j.vaccine.2019.04.095

This article originally appeared on Clinical Pain Advisor