Varicella zoster virus vaccines: an update

Area of Science:

• Immunology
• Virology
• Vaccinology

Background:

• Varicella zoster virus (VZV) causes varicella (chickenpox) and herpes zoster (shingles) upon reactivation.
• Declining cell-mediated immunity (CMI) with age or immunosuppression triggers VZV reactivation as shingles.
• VZV vaccination strategies aim to prevent primary infection and disease complications.

Purpose of the Study:

• To review the impact of VZV vaccination on varicella incidence and complications.
• To discuss the current landscape of shingles (herpes zoster) prevention through vaccination.
• To highlight recommendations for available herpes zoster vaccines.

Main Methods:

• Review of existing literature on VZV and HZ epidemiology and vaccination.
• Analysis of vaccine efficacy, safety, and tolerability data.
• Examination of current guidelines and recommendations for VZV and HZ vaccines.

Main Results:

• Universal varicella vaccination has substantially decreased varicella incidence, complications, and mortality.
• Two HZ vaccines are available: recombinant zoster vaccine (RZV) and Zoster Vaccine Live (ZVL).
• The Advisory Committee on Immunization Practices (ACIP) preferentially recommends RZV for HZ prevention.

Conclusions:

• VZV vaccination is highly effective in preventing primary varicella infection.
• HZ vaccination is crucial for mitigating the burden of shingles and its complications.
• RZV is the preferred vaccine for HZ prevention, while ZVL remains an option for immunocompetent older adults, though its CMI wanes over time.