Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Oct;60(10):1343-1349.
doi: 10.1007/s00592-023-02127-7. Epub 2023 Jun 20.

Efficacy and effectiveness of Herpes zoster vaccination in adults with diabetes mellitus: a systematic review and meta-analysis of clinical trials and observational studies

Giovanni Antonio Silverii  1 , Alessandra Clerico  2 , Riccardo Fornengo  3 , Giovanni Gabutti  4 , Valeria Sordi  5 , Ottavia Peruzzi  1 , Silvio Tafuri  6 , Edoardo Mannucci  1 , Ilaria Dicembrini  7
Affiliations
Meta-Analysis

Efficacy and effectiveness of Herpes zoster vaccination in adults with diabetes mellitus: a systematic review and meta-analysis of clinical trials and observational studies

Giovanni Antonio Silverii et al. Acta Diabetol. 2023 Oct.

Abstract

Aim: The risk for Herpes zoster (HZ) and its complications is higher in people with diabetes mellitus (DM). Our aim is to assess efficacy and effectiveness of the currently available live-attenuated zoster vaccine (LZV) and recombinant zoster vaccine (RZV) in adults with DM.

Methods: A Systematic Review and Meta-analysis of clinical trials and observational studies comparing incidence of HZ and its complications in vaccinated and unvaccinated people with DM was performed, on PubMed, Cochrane, Clinical Trials.gov and Embase databases, up to January 15th, 2023. Risk of bias was assessed through the Cochrane Collaboration tool and the Newcastle-Ottawa Scale. The protocol was registered on the PROSPERO website (CRD42022370705).

Results: Only three observational studies reported LZV efficacy and effectiveness in people with DM. A lower risk for HZ infection (MH-OH Ratio 95% CI = 0.52 [0.49, 0.56] was observed, for unadjusted analysis, and 0.51 [0.46, 0.56] for adjusted analysis, both with P < 0.00001 and no heterogeneity). No data on LZV safety were reported. A pooled analysis of two trials comparing RZV and placebo, showed a reduced risk for HZ incidence: (95% CI Odds Ratio: 0.09 [0.04-0.19]), with no difference in severe adverse events and mortality.

Conclusions: In our meta-analysis of three observational studies LZV showed a 48% effectiveness in reducing HZ incidence in adults with diabetes whereas in a pooled analysis of two RCTs, RZV showed a 91% efficacy. No data are available on the effects of vaccination on the incidence and severity of HZ-related complications among subjects with diabetes.

Keywords: Diabetes; Efficacy and effectiveness of Herpes zoster vaccination; Herpes zoster vaccine; Herpes zoster-related severe outcome; Meta-analysis.

PubMed Disclaimer

Conflict of interest statement

GG declares fees from Sanofi Pasteur MSD, Pfizer, GSK Biologicals SA, Sanofi Pasteur, MSD Italy, Emergent BioSolutions, Moderna and Seqirus for taking part to advisory boards, expert meetings, for acting as speaker and/or organizer of meetings/congresses and as principal investigator and chief of O.U. in RCTs. All the others authors have no conflict of interest to disclose directly related to this manuscript.

Figures

Fig. 1
Fig. 1
Differences in incidence of Herpes Zoster between vaccinated or unvaccinated (live attenuated vaccine, LZV) patients with diabetes mellitus, unadjusted odds ratio. M-H = Mantel Haenszel; CI = Confidence Intervals
Fig. 2
Fig. 2
Differences in incidence of Herpes Zoster between vaccinated or unvaccinated (live attenuated vaccine, LZV) patients with diabetes mellitus, adjusted odds ratio. IV = Inverse Variance; SE = Standard Error CI = Confidence Intervals
See this image and copyright information in PMC

References

    1. Cohen JI. Herpes Zoster. N Engl J Med. 2013;369(3):255–263. doi: 10.1056/NEJMcp1302674. - DOI - PMC - PubMed
    1. Galil K, Choo PW, Donahue JG, Platt R. The sequelae of herpes zoster. Arch Intern Med. 1997;157(11):1209–1213. doi: 10.1001/archinte.1997.00440320105010. - DOI - PubMed
    1. Kawajiri S, Tani M, Noda K, Fujishima K, Hattori N, Okuma EY. (2007) Segmental Zoster Paresis of limbs: report of three cases and review of literature. Neurol. 2007;13(5):313–317. doi: 10.1097/NRL.0b013e31811e9d6d. - DOI - PubMed
    1. Votrubec M, Thong EI. Neuropathic pain–a management update. Aust Fam Phys. 2013;42(3):92–97. - PubMed
    1. Hillebrand K, Bricout H, Schulze-Rath R, Schink T, Garbe E. Incidence of herpes zoster and its complications in Germany, 2005–2009. J Inf. 2015;70(2):178–186. doi: 10.1016/j.jinf.2014.08.018. - DOI - PubMed

Substances