Making the case for universal herpes zoster vaccination in older adults

Reactivation of the varicella-zoster virus (VZV) causes herpes zoster (HZ, or shingles), which can lead to painful postherpetic neuralgia (PHN). Vaccination against HZ can reduce the occurrence of HZ and PHN, but vaccination rates are low in the older adult population, particularly among residents of long-term care (LTC) facilities, who are at highest risk of developing HZ and its potentially disabling and sometimes life-threatening sequelae. In addition, the live attenuated HZ vaccine (Zostavax, Merck & Co) is contraindicated in immunocompromised persons, a population that is highly represented in LTC settings. The recent availability of a newer non-live, recombinant, adjuvanted HZ vaccine (Shingrix, GlaxoSmithKline) offers the potential for a larger population to gain protection against VZV reactivation and its associated complications. Accordingly, we call for universal vaccination against HZ in the older adult population, especially among LTC residents. More real-world long-term studies are needed to assess the safety, adverse effects, and effectiveness of the non-live vaccine in the older old (persons aged 70 years or more), immunocompromised persons, and older adults with multimorbidity.