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The herpes zoster ophthalmicus vaccine Zostavax (zoster vaccine live, Merck) was shown to decrease
the incidence of developing zoster or shingles by more than 50%.¹ So, how is it possible that
the incidence of shingles has actually increased over the last three years, and will continue to increase
over the next 10 years?²
Surprisingly, the answer likely is associated with another vaccine—the chicken pox antigen for children!
The leading hypothesis is that when grandparents (who are at the age most at risk for shingles) are exposed to
their grandchildren who have recently developed chicken pox, the grandparents inadvertently receive
an "immune booster" from secondary exposure to the varicella virus.³ With the introduction of the varicella
vaccine, however, children are no longer developing chicken pox and therefore grandparents are not receiving
this booster.
This one factor alone appears to be the reason for the significant increase in the incidence of herpes zoster,
even in the presence of a very effective shingles vaccine.
1. Sanford M, Keating GM. Zoster vaccine (Zostavax): a review of its use in preventing herpes zoster and postherpetic neuralgia in older adults. Drugs Aging. 2010 Feb 1;27(2):159-76.
2. Rimland D, Moanna A. Increasing incidence of herpes zoster among veterans. Clin Infect Dis. 2010 Apr 1;50(7):1000-5.
3. Leung J, Harpaz R, Molinari NA, et al. Herpes zoster incidence among insured persons in the United States, 1993-2006: evaluation of impact of varicella vaccination. Clin Infect Dis. 2011 Feb 1;52(3):332-40.
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