Abstract
Background: Vaccination against herpes zoster was introduced in the United Kingdom in 2013 for individuals aged 70 years, with a phased catch-up campaign for 71–79 year olds. Vaccine introduction has resulted in a marked fall in incident herpes zoster and in post-herpetic neuralgia (PHN), but formal evaluation of vaccine effectiveness is needed. Methods: In a population-based cohort study of older individuals born between 1933 and 1946, we used linked UK anonymised primary care health records for the first three years of the vaccination programme (01/09/2013–31/08/2016) and multivariable Poisson regression to obtain incidence rates and vaccine effectiveness (VE) against zoster and PHN. Results: Among 516,547 individuals, 21% were vaccinated. Incidence of zoster was 3.15/1000 person-years in vaccinees and 8.80/1000 person-years in unvaccinated individuals. After adjustment, VE was 64% (95%CI = 60–68%) against incident zoster and 81% (95%CI = 61–91%) against PHN, with very similar VE estimates in the routine and catch-up cohorts. VE against zoster was lower in those with a previous history of zoster: 47% (95%CI = 31–58%) versus 64% (95%CI = 60–68%) in those without previous zoster. There was evidence of waning VE over time, from 69% (95%CI = 65–74%) in the first year after vaccination to 45% (95%CI = 29–57%) by the third year. Conclusion: This first formal assessment of VE in the UK zoster vaccination programme demonstrates good effectiveness of zoster vaccine, and very good protection against PHN. The findings provide evidence that VE is similar across the age groups targeted for vaccination in the UK, and on duration of protection of the vaccine in public health use. The study provides key information for decision-makers about the future direction of UK zoster vaccination programme, indicating that the live zoster vaccine may be more cost-effective than estimated previously. It also supports efforts to communicate the benefits of zoster vaccination to address the declining coverage observed across the UK.
| Original language | English |
|---|---|
| Pages (from-to) | 2371-2377 |
| Number of pages | 7 |
| Journal | Vaccine |
| Volume | 36 |
| Issue number | 17 |
| DOIs | |
| Publication status | Published - 19 Apr 2018 |
Bibliographical note
Funding Information:This research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Immunisation at the London School of Hygiene and Tropical Medicine in partnership with Public Health England (PHE). SML is supported by a Wellcome senior research fellowship in clinical science (205,039/Z/16/Z). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health, the Wellcome Trust or Public Health England. The funders had no role in the study design, data collection, analysis or interpretation of the data, in the writing of the manuscript or in the decision to submit the paper for publication.
Publisher Copyright:
© 2018 The Authors
Keywords
- Effectiveness
- Electronic health records
- General practice
- Herpes zoster
- United Kingdom
- Vaccine
