A new recombinant herpes zoster subunit vaccine has been shown in clinical trials to be efficacious and safe. It holds promise for reducing the burden of herpes zoster and its complications, particularly the pain of postherpetic neuralgia, for older people and immunocompromised patients, who are most at risk. However, until the new vaccine becomes available in Australia, the existing live attenuated vaccine has an ongoing and important role in clinical practice.
Herpes zoster (HZ), or shingles, is caused by reactivation of latent varicella zoster virus (VZV). During initial infection with VZV, which presents clinically as chickenpox, the cervical and peripheral sensory ganglia become latently infected, probably through the bloodstream. VZV then remains latent in the sensory ganglia for life.1 As 95% of adults in the developed world who were born in the pre-varicella vaccination era have had varicella by the age of 30 years, most are at risk of developing HZ.