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Herpes zoster (HZ) is a sequela of the reactivation of a latent varicella zoster virus (VZV) infection of the sensory dorsal root ganglia and cranial nerves due to a decrease in specific T cell-mediated immunity as a result of immunosenescence, immunodeficiency diseases, e.g., human immunodeficiency virus (HIV) infection or immunosuppressive therapy. The disease burden of HZ greatly increases with age; however, younger patients with, e.g., inflammatory rheumatic diseases, also have an increased risk of HZ, which is higher under certain immunosuppressive drugs, e.g., Janus kinase (JAK) inhibitors or glucocorticoids. The risk of complications, e.g., postherpetic neuralgia (PHN) is also increased in this patient group. Of the two vaccines licensed in Germany, the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute recommends the recombinant adjuvanted HZ subunit vaccine for the standard vaccination of all persons ≥ 60 years and for persons ≥ 50 years with an increased HZ risk for prevention of HZ and PNH due to its better efficacy and longer duration of effectiveness. Clinical trials have demonstrated a 90-97% efficacy in preventing HZ in immune healthy adults aged ≥ 50 years, with a much higher reactogenicity in the vaccine group compared to placebo. Adequate efficacy, immunogenicity and safety have also been demonstrated in clinical trials in immunocompromised and immunosuppressed patients. An extension of the STIKO vaccination recommendation to all adults with an increased HZ risk in line with the approval would be welcome., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Objectives: After introduction of a herpes zoster (HZ) vaccine in Germany in 2013, a potential recommendation by the German Standing Vaccination Committee is still pending. This study estimated data on the disease burden of HZ in Germany to extend the data basis for the decision process., Methods: A retrospective cohort study on data from 7 million statutory health insurance members from 2005 to 2009 was conducted. HZ cases were identified using ICD-10-codes. IRs of HZ and complications were estimated overall, by age, sex and immune status. The proportion of postherpetic neuralgia (PHN), hospitalizations, the diagnosing physician specialty and systemic antiviral therapy were assessed., Results: Annual standardized IRs ranged between 5.3 and 5.5 per 1000 person-years (PY) between 2006 and 2009 with higher IRs in females. In 2009, 72.4% of HZ patients were without complications, while 15.5% suffered from nervous system involvement. The age-related increase was higher for HZ complications than for uncomplicated HZ. Immunocompromised patients suffered slightly more complications than immunocompetent patients. The PHN proportion increased to 15% in 2009 with a steady age-related increase. About 3% of HZ cases were hospitalized., Conclusions: Age-related increases of HZ complications and PHN suggest that particularly older patients might benefit from HZ vaccination., (Copyright © 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)