Shingles (Herpes Zoster) vaccine (live) powder and solvent for suspension for injection 0.65ml pre-filled syringes

Background and objectiveSeveral systematic reviews and meta-analyses have been published with conflicting results on the risk of herpes zoster after coronavirus disease 2019 (COVID-19) vaccination. We aimed to study the risk of herpes zoster after COVID-19 vaccination using electronic health record data of general practices, from a large cohort in the Netherlands.MethodsPersons aged ≥ 12 years who received at least one COVID-19 vaccination and were registered in the general practice databases of PHARMO and Nivel Primary Care Database were included. This study used a self-controlled design comparing the risk of herpes zoster in the risk period (28 days after COVID-19 vaccination) with the control period. Poisson regression was used to calculate incidence rate ratios, adjusting for severe acute respiratory syndrome coronavirus 2 infection.ResultsThere were 2,098,683 COVID-19 vaccinated persons aged ≥ 12 years included, of whom 1,058,646 (50.4%) were female. An increased risk for herpes zoster was found after all the doses grouped together and the third dose of all COVID-19 vaccination (adjusted incidence rate ratio: all doses 1.07, 95% confidence interval [CI] 1.02-1.13 and third dose 1.21, 95% CI 1.05-1.38). After stratification on vaccine type, all doses and the third dose of messenger RNA vaccination (adjusted incidence rate ratio: all doses 1.06, 95% CI 1.00-1.12 and third dose 1.21, 95% CI 1.05-1.40) showed an increased risk.ConclusionsOur study showed a slight increased risk of herpes zoster when taking into account all doses and all types of vaccines. After stratification on vaccine type, no increased risk of herpes zoster after the primary vaccination series and a slightly elevated risk after the third/booster vaccination with a messenger RNA vaccine were found.

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Abstract Background The recombinant zoster vaccine (RZV; Shingrix, GSK) was licensed in 2017 for prevention of herpes zoster (HZ) in adults aged ≥ 50 years. Accumulating observational and quasi-experimental data suggest that RZV confers broad immunological benefits beyond HZ prevention including attenuation of dementia, cardiovascular events, and all-cause mortality. We conducted the first comprehensive systematic review and meta-analysis quantifying these pleiotropic effects and their biological underpinnings. Methods We searched MEDLINE, Embase, Cochrane CENTRAL, and LILACS (2004–March 2026). Studies reporting dementia, cardiovascular, or mortality outcomes in adults aged ≥ 50 years receiving RZV or live-attenuated zoster vaccine (ZVL), with ≥ 6 months follow-up and a comparator group, were eligible. Random-effects meta-analyses (DerSimonian–Laird) produced pooled Risk Ratios (RR) or Hazard Ratios (HR) with 95% confidence intervals. Heterogeneity was assessed via I² and Cochran Q. Certainty of evidence was rated using GRADE. Results Forty-seven studies (N > 2,500,000) met inclusion criteria; 47 were analysed qualitatively and 19 quantitatively. RZV vaccination was associated with a 18% reduction in all-cause dementia (pooled RR 0.82, 95% CI 0.75–0.88; I² = 34%), an 18% reduction in major adverse cardiovascular events (RR 0.82, 95% CI 0.76–0.87; I² = 28%), and an 18% reduction in all-cause mortality (HR 0.82, 95% CI 0.76–0.88; I² = 18%). Vascular dementia showed the strongest signal (RR 0.50, 95% CI 0.38–0.65). Duration of protection exceeded 11 years. The AS01B adjuvant system drove polyfunctional CD4 + TH17 responses unprecedented among licensed vaccines for older adults. Conclusions RZV exhibits a pleiotrop dedicated randomised controlled trials targeting dementia and cardiovascular endpoints as co-primic longevity profile not observed with other vaccines. The convergence of anti-inflammaging, neuroprotective, and cardioprotective mechanisms positions RZV as a candidate longevity intervention warranting ary outcomes. Universal uptake could prevent millions of dementia cases and cardiovascular events globally.

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Herpes zoster (HZ) is a reactivation of varicella-zoster virus (VZV), which has been traditionally associated with aging and immunosuppression. However, new data indicate that the coronavirus disease 2019 (COVID-19) pandemic has changed HZ epidemiology, with a higher incidence of HZ in post-COVID-19 patients and vaccinated subjects. This systematic review assesses the trends and triggers of HZ as well as the impact after the pandemic, focusing on the changes in the incidence rate among adult and pediatric patients during the last 10 years. All studies published between the years of 2014 and 2024 were accrued, based on a systematic review conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified from searches of databases and other sources. Eligibility criteria of studies were applied, and qualitative and quantitative syntheses of studies were performed. A total of 11 studies were included in the review, which examined the association between COVID-19, vaccination, and HZ risk. Several studies suggested that psychological stress and immune dysfunction could be risk factors for HZ incidence. HZ cases after COVID-19 vaccination have been reported, although causation is not established. Based on countries in which COVID-19 was diagnosed, hospitalizations are estimated at 14.4 per 100,000 inhabitants (0.6 to 32.9 per 100,000), and mortality was 1.3 per 100,000, points in this IR Batch (assuming that these are of all diagnosed cases). The risk of HZ reactivation may be increased following COVID-19 infection and vaccination. Higher hospitalization rates with higher mortality risks and neurological consequences were also observed in some populations. Strengthening HZ vaccination programs and studying post-COVID-19 immune responses further can be essential for reducing long-term health risks.

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Introduction Herpes zoster (HZ), also known as shingles, is characterized by a vesicular skin rash, often associated with acute pain and itching. The safety profile of the recombinant zoster vaccine (RZV) in adults aged 50 years and older and in adults aged 18 and older who are at increased risk of HZ was assessed in this systematic review. Methods A comprehensive electronic search was performed in Embase, MEDLINE, the Cochrane Library, and clinical trials registries. Searches were limited to the period from 2008 to July 2023. Article screening and data extraction were carried out by two independent reviewers. Risk of bias was assessed using the Cochrane revised Risk of Bias 2 (RoB2) tool for randomized controlled trials (RCTs). The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool was used to assess the quality of non-randomized studies. An adapted version of the Newcastle–Ottawa Scale was used for the appraisal of quality of non-comparative studies. Results Eighteen RCTs, four observational cohort studies, seven single-arm trials, and 11 single-arm observational studies were identified. Compared with placebo, solicited local (RZV: 74.1 to 84.0%; placebo: 7.9 to 11.9%) and systemic reactions (RZV: 53.0 to 66.1%; placebo: 6 to 11.4%) were more common in the vaccinated cohorts. Reactions were generally transient and mild to moderate in intensity. The most frequent reactions reported were pain at the reaction site, fatigue, and myalgia. The incidence of potential immune-mediated diseases (pIMDS), serious adverse events (SAEs), and fatalities was similar in vaccine and placebo groups. No SAEs, pIMDs, or deaths were reported as vaccine related. Conclusions The available data on RZV shows that while local and systemic adverse events are common with RZV, these are typically transient, and SAEs are uncommon in both the general population and those at increased risk of HZ.

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Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), has been associated with a wide range of dermatological manifestations. Herpes zoster (HZ), also known as shingles, has been increasingly reported in adults with COVID‑19 infection. Several reports suggest that SARS‑CoV‑2-associated immune dysregulation, particularly lymphopenia and impaired T-cell-mediated immunity, may contribute to varicella-zoster virus (VZV) reactivation. This systematic review aimed to evaluate the temporal relationship between COVID‑19 infection and shingles rash, including the onset, clinical outcomes, prognostic implications, recovery, and relationship with lymphopenia. This study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature review was conducted using PubMed, MEDLINE and Cochrane databases for studies published within the last five years. Search terms included "COVID‑19", "SARS-CoV-2", "herpes zoster" and "shingles rash". Inclusion criteria consisted of case reports, case series, cohort studies, systematic reviews, and research studies. Studies included were in the English language. Studies not relevant to the research question, paediatric cohorts, or commenting on vaccination were excluded. Fifty-seven studies (N=57) were initially identified through database search, with 35 studies (N=35) deemed relevant to the research question following screening. Twenty-five studies (N=25) were excluded due to data not being relevant to the research question, paediatric cohort data, or vaccination-related data. After exclusion, 10 studies (N=10) were included in the review for qualitative analysis. Most studies demonstrated a temporal association between COVID‑19 infection and HZ occurrence. HZ rash developed from two days before COVID‑19 symptoms and up to 70 days after infection, with an average onset approximately 17 days after COVID‑19 diagnosis. Several studies reported that HZ preceded or coincided with COVID‑19 symptoms, suggesting that shingles may serve as an early indicator of SARS‑CoV‑2 infection. Associated lymphopenia was noted, suggesting that COVID-19-induced immune dysregulation contributes to VZV reactivation. Most patients recovered from HZ rash following antiviral therapy, although severe complications and prolonged hospitalisation were observed in cases involving co-infection and systemic disease. Overlooking this possible association may result in an undiagnosed COVID-19 infection in those presenting with shingles rash and a higher risk of developing long COVID. The reviewed studies indicate that COVID-19 may be associated with HZ reactivation in the general adult population, although causality remains unproven. This detailed data analysis and systematic review demonstrate that evidence is scarce in this domain, which warrants larger epidemiological and immunological studies as well as further meta-analyses to determine the prognostic significance of shingles rash in COVID‑19 infection, in particular long COVID.

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BackgroundHerpes zoster (HZ) results from reactivation of latent varicella-zoster virus and is a major cause of morbidity, particularly among older adults and immunocompromised individuals. Post-herpetic neuralgia (PHN), the most common chronic complication of HZ, is characterized by persistent neuropathic pain that can substantially impair quality of life. Despite advances in antiviral therapy and vaccination, PHN remains a significant clinical challenge. This review presents current evidence on the epidemiology, risk factors, pathophysiology, clinical manifestations, prevention, and management of HZ and PHN, with emphasis on factors associated with PHN development and contemporary therapeutic approaches.MethodsA narrative review of the literature was conducted using publications indexed in PubMed, Scopus, Web of Science, and Google Scholar from January 2010 to June 2026. Peer-reviewed studies, systematic reviews, meta-analyses, randomized controlled trials, cohort studies, and clinical guidelines addressing HZ, PHN, and related management strategies were included. Findings were synthesized narratively.ResultsAdvanced age, severe acute zoster pain, extensive rash involvement, prodromal pain, and immunocompromised status were consistently identified as major predictors of PHN. Early initiation of antiviral therapy within 72 h of rash onset was associated with reduced acute disease severity and may decrease the risk of prolonged pain. Evidence supports the use of gabapentinoids, tricyclic antidepressants, topical lidocaine, and capsaicin for PHN management, while multidisciplinary approaches incorporating non-pharmacologic interventions may further improve outcomes. Recombinant zoster vaccination demonstrates high effectiveness in preventing HZ and PHN in older adults.ConclusionPHN remains a substantial source of long-term morbidity following HZ, particularly in aging populations. Early recognition of high-risk patients, prompt antiviral treatment, evidence-based pain management, and wider uptake of recombinant zoster vaccination are key strategies for reducing disease burden and improving patient outcomes.

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Background/objectivesDementia represents a major global health challenge, and preventive strategies remain limited. Observational studies have suggested a possible association between herpes zoster vaccination (HZV) and dementia risk, although the influence of vaccine type and dose regimen remains unclear.MethodsPubMed, Embase, and Web of Science were searched through January 2026. The primary random-effects meta-analysis included one adjusted estimate per independent study or data-source cluster. Quasi-experimental and correlated secondary estimates were reported separately, and alternative-estimate and leave-one-out analyses retained independent statistical units. The protocol was registered in PROSPERO (CRD420261326042).ResultsFourteen reports representing 13 studies were included. HZV was associated with a lower dementia risk in the primary analysis of five independent data sources (ratio estimate = 0.72; 95% CI: 0.65-0.81; I2 = 97.1%), with similar sensitivity results (0.70-0.76). Two regression-discontinuity studies reported eligibility-associated absolute reductions in dementia diagnosis of 1.3 and 1.8 percentage points. Two direct vaccine comparisons favored the recombinant zoster vaccine (RZV; Shingrix) over the live attenuated vaccine (ZVL; Zostavax) (RMTL ratio = 0.83; 95% CI: 0.80-0.87; RR = 0.82; 95% CI: 0.69-0.98). The only direct dose comparison favored two or more RZV doses over one dose (RR = 0.81; 95% CI: 0.74-0.88). Active-comparator associations were generally attenuated, whereas age- and subtype-specific findings varied. These secondary findings were exploratory.ConclusionsHZV was associated with lower dementia risk in observational studies, with directionally consistent quasi-experimental findings. Direct evidence suggested potentially stronger inverse associations for RZV and complete vaccination, but was based on few independent data sources. Substantial heterogeneity and residual confounding preclude causal interpretation, and further prospective or randomized evidence is needed.

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