CIC recommendations for zoster immunization

Volume 40-9, May 1, 2014: Immunization

CIC Recommendations

Summary of the CIC Recommendations for zoster immunization programs

Canadian Immunization Committee¹*

Affiliation

¹ The Canadian Immunization Committee (CIC) provides operational and technical advice related to immunization policies and programs in Canada. CIC consists of representatives from provincial and territorial jurisdictions, the National Advisory Committee on Immunization (NACI), the American Advisory Committee on Immunization Practices (ACIP) and Health Canada's Biologics and Genetic Therapies Directorate (BGTD), Marketed Health Products Directorate (MHPD), and First Nations and Inuit Health Branch.

Correspondence

cic-cci@phac-aspc.gc.ca

DOI

https://doi.org/10.14745/ccdr.v40i09a02

Introduction

Zoster infection results from the reactivation of the varicella zoster virus and typically occurs many years after primary infection. Varicella zoster virus is associated with chicken pox in childhood and zoster infection in adulthood. The overall incidence of zoster is increasing in Canada, the elderly being the most susceptible. Immunocompromised persons are also an increased risk of zoster infection. Zoster infection is characterized by neuropathic pain and a dermatomal rash, and carries a lifetime risk of 15% - 28% in Canada. Complications of zoster infection occur in 13% - 40% of cases. The most frequent complication is pain, including post-herpetic neuralgia, which is significant pain persisting longer than 90 to 120 days after rash onset. Post-herpetic neuralgia has a significant adverse impact on quality of life and occurs in one-third of zoster cases over the age of 60, the risk increasing with age. On the basis of scientific evidence, the National Advisory Committee on Immunization recommends zoster vaccine for the prevention of zoster and its complications in persons 60 years and older without contraindications and recommends that it may be used in those aged 50-59 years. Zoster vaccine is currently not publicly funded in Canada. This document is a brief summary of the full report of the Canadian Immunization Committee (CIC) zoster recommendations ^{Reference 1}. Recommendations for Zoster Immunization Programs.

Objective

To consider whether a population-based, publicly funded zoster vaccine program can be recommended.

Approach

The CIC statement considered the disease characteristics and burden of illness; vaccine safety and efficacy; immunization strategies and programs; cost-effectiveness; feasibility and acceptability; ability to evaluate a zoster immunization program; outstanding research questions; and equity, ethical and political considerations.

Findings

Zostavax® is a live, attenuated zoster vaccine approved for use in Canada in those aged 50 years and older without contraindications. The efficacy and safety of Zostavax® have been demonstrated through the Shingles Prevention Study and related substudies; the duration of protection beyond 7 years is uncertain, and studies to 10 years are in progress.

The delivery of zoster vaccine can be optimized by coadministration with influenza and pneumococcal vaccines given to older adults. A review of cost-effectiveness analyses from 12 publications from seven countries indicates that cost-effectiveness is maximized when zoster vaccine is given to adults between the ages of 60-69.The feasibility of a zoster immunization program may be affected by the need for the present formulation to be frozen. However, it is currently projected that a refrigerator-stable formulation will be available in Canada starting March 2014, which will likely improve feasibility.