Abstract

The STIKO recommends vaccination with the adjuvanted herpes zoster subunit (HZ/su) inactivated vaccine for the prevention of herpes zoster (HZ) and postherpetic neuralgia (PHN) for all people age 60 years and over (standard vaccination).
This recommendation takes into account the good efficacy of the vaccine, the anticipated period of protection it provides, and the increased risk of severe HZ disease and post-zoster pain in individuals age 60 years and over. Models of the epidemiological effects of vaccination show that administering the HZ/su vaccine at age 60 years has the greatest effect in preventing all HZ cases, and administering the vaccine at age 70 years showed the greatest effect in preventing PHN, in a vaccinated cohort. According to the results of a health economics model, the lowest cost per quality-adjusted life year (QALY) would be achieved with vaccination at age 65 years. The number of people who need to be vaccinated (number needed to vaccinate, NNV) to prevent one case of HZ is the same for both vaccination ages (60 and 65 years). In light of the fact that preventing HZ is the key prerequisite to preventing complications and late sequelae such as PHN, 60 years of age is considered the most favorable age for vaccination, to prevent both HZ and its complications.
The STIKO also recommends vaccination against HZ and PHN with the HZ/su inactivated vaccine for all people from the age of 50 years who have an elevated risk of HZ and PHN owing to increased health risks as a consequence of an underlying disease or immunosuppression (indication-based vaccination). This group includes e. g. people with congenital or acquired immunodeficiency or immunosuppression, HIV infection, rheumatoid arthritis, systemic lupus erythematosus, chronic inflammatory bowel disease, chronic obstructive pulmonary disease (COPD) or bronchial asthma, chronic renal disease, diabetes mellitus.
The efficacy and safety of the vaccine for patients with impaired immune systems have been demonstrated in numerous studies.
Stratified data analyses on the efficacy of the vaccine have shown no difference in comparison to overall efficacy for patients with an underlying disease, e. g., rheumatoid arthritis, chronic renal disease, COPD, or diabetes mellitus, who were enrolled in vaccine marketing authorization studies.

Background paper Europe Germany