ACIP Recommendations to Bolster Herpes Zoster Prevention

ACIP Recommendations to Bolster Herpes Zoster PreventionThe Advisory Committee on Immunization Practices (ACIP) has successfully been able to dictate the guidelines and use of vaccines for 54 years, and that trend will carry over to one of their latest decisions on how to combat Herpes Zoster (HZ), also known as shinACIP Recommendations to Bolster Herpes Zoster Preventiongles. Currently, Vickery Vaccine has been very active in combating HZ, administering vaccines to counter it almost daily.

According to, the ACIP was founded in 1964. They are a board made up of 15 voting members, all of which are experts in the medical field, and are selected by the Secretary of the U.S. Department of Health and Human Services (DHHS). Over a period of time, they discuss how the development of the U.S. vaccines should apply and operate within the country. There are dozens of steps they take, but they can essentially be boiled down to; development and testing, acquiring the FDA license, and the uptakes and financing.

On October 2017 in particular, the ACIP turned their attention to the prevention of HZ. According to an article from the Centers for Disease Control and Prevention website, the following recommendations were made: The vaccine, known as the recombinant zoster vaccine (RZV) is recommended for the prevention of herpes zoster and related complications for immunocompetent adults under the age of 50. RZV is recommended for the prevention of herpes zoster and related complications for immunocompetent adults who previously received zoster vaccine live (ZVL). And, RZV is preferred over ZVL for the prevention of herpes zoster and other related complications. ZVL has been licensed in the U.S. since 2006.

According to, HZ begins as chicken pox and is described as a sort of “one-two punch.” Once the chicken pox expires, it retreats into the spinal and brain tissue where it can remain hidden for almost a decade. Once it resurfaces, it can cause burning and stabbing pain where rashes inevitably appear on the body. It has been reported that 90% of HZ episodes are associate with pain. In some cases, postherpetic neuralgia (PHN) can develop 90 days after the rash, which can be very painful.

HZ prevention involves antivirals that can reduce the duration of the rash and pain. Unfortunately, the prevention for PHN, if it gets that far, is very minimal. It has been documented that some patients, particularly the elderly, have said that the PHN can potentially get more painful than the cancer and chemotherapy. There have been 1 million reported cases of HZ annually, with the range of affected people getting more the older they get. For adults in particular with HZ, 10-18% will develop the painful PHN, evidence also suggests that this statistic increases with age.

With a disease as formidable as HZ, it has come into question if the ACIP’s recommendations are as effective as we hope they are. Fortunately, data proves that the RZV is very effective against HZ, with a 97% efficiency with patients 50-69 years old, and a 91% efficiency with patients over 70. No differences have been detected between vaccinated and comparison populations for serious adverse events.

Data supports that RZV is more effective than ZVL in all age categories, with a steeper difference in older ages. In fact, it has been proven that ZVL’s protection is waning, and that RZV has been significantly efficacious over 4 years, with VE > 97% in the first year which is maintained >85% during the first 4 years for all ages. Furthermore, 20 million people that have been vaccinated with ZVL could possibly be treated with RZV as well.

Despite not being studied in a head-to-head trial, RZV is preferred over ZVL, regarding the statistics provided earlier. Neither vaccine is associated with serious adverse events in immunocompetent people. RZV is refrigerator stable, and does require reconstitution prior to administration, with 2 doses at 0 and 2-6 months. RZV can be co-administered with QIV (Fluarix) with to interference or safety problems, while there are still studies determining if PPSV23 (Pneumovax23) or Tdap (Boostrix) are safe, and Fluad has not been studied at this time.

The data speaks for itself, proving that the ACIP continues to make the correct decisions in the medical community for patients across the country. With the amount of success that has accumulated in the past several months regarding combating HZ, it is exciting to learn what sort of breakthroughs we will see next.

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