Vaccination for preventing postherpetic neuralgia.

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BACKGROUNDHerpes zoster virus vaccine was recommended for the prevention of herpes zoster and its sequelae by the Advisory Committee on Immunization Practices (ACIP) in 2006. To date the efficacy and safety of vaccination for preventing the most common complication of zoster, postherpetic neuralgia, has not been systematically reviewed.OBJECTIVETo assess the efficacy and safety of vaccination in preventing postherpetic neuralgia.METHODSTwo authors independently assessed trial quality, then extracted and analysed data from the trials which met the inclusion criteria. We collected adverse effects information from the trials.RESULTSOne trial, which involved 38,546 subjects and compared vaccination with placebo, met our inclusion criteria. This included study was of high quality. However, its participants were all aged 60 years or more and most of them were white, which may mean that its findings are not applicable to all populations. The vaccine was effective in decreasing the incidence of herpes zoster, but there was no evidence that it had efficacy in reducing the incidence of postherpetic neuralgia beyond its effect on the incidence of herpes zoster. Adverse events at the injection site were more common among vaccine recipients than placebo recipients, but they were mild and resolved in a few days. Serious adverse events were rare.CONCLUSIONSThere is insufficient direct evidence from specialised trials to prove the efficacy of vaccine for preventing postherpetic neuralgia beyond its effect on reducing herpes zoster, although vaccination may be efficacious and safe for preventing herpes zoster and thus reduce the incidence of postherpetic neuralgia in adults aged 60 years or older.

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