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. 2025 Jun;14(6):1327-1341.
doi: 10.1007/s40121-025-01161-y. Epub 2025 May 21.

The Potential Impact of Increased Recombinant Zoster Vaccine Uptake in Older Adults Worldwide

Nikolaos Giannelos  1 , Desmond Curran  1 , Sean Matthews  2 , Justin Carrico  3 , Anthony L Cunningham  4
Affiliations

The Potential Impact of Increased Recombinant Zoster Vaccine Uptake in Older Adults Worldwide

Nikolaos Giannelos et al. Infect Dis Ther. 2025 Jun.

Abstract

Introduction: Herpes zoster (HZ, Shingles) is a vaccine-preventable viral disease impacting patients' quality of life owing to pain and rash. An estimated 15 million HZ cases occur annually in individuals aged ≥ 50 years worldwide. Recombinant zoster vaccine (RZV) is effective in protecting against HZ. This is the first study evaluating the potential incremental public health benefits in terms of HZ cases averted worldwide by vaccinating adults aged ≥ 50 years with RZV.

Methods: A previously published static multi-cohort Markov model with an annual cycle length and lifetime horizon was used for all analyses. Demographic data depicting populations on 31 December 2023, and age-sex specific mortality rates by region were sourced from United Nations (2022). HZ incidence rates were informed from a recent meta-regression analysis of global HZ burden (Asia, Europe, Northern America, Oceania, and worldwide). RZV efficacy and waning modelling was based on 11-year clinical trial follow-up data [NCT02723773].

Results: Assuming 70% second-dose compliance in the general population aged ≥ 50 years worldwide, increased RZV uptake by 5% reduced the number of expected HZ cases by > 10 million over the vaccinated cohort's remaining lifetime. More than 5 million of the averted cases were among the cohort vaccinated at ages 50-59 years. Numbers needed to vaccinate (NNV) to avert one HZ case worldwide ranged from 9 at 50-59 years to 18 at ≥ 80 years-of-age, with an overall NNV of 10 for the entire cohort aged ≥ 50 years. Variations observed by region and vaccination age reflected varying inputs, i.e., population counts, HZ incidence rates, mortality rates, and vaccine efficacy waning by age.

Conclusions: A modest (5%) increase in absolute RZV uptake worldwide was estimated to avert millions of additional HZ cases. Lower NNVs were observed in younger vaccinated cohorts irrespective of region, outlining the merits of long-term protection afforded by RZV, and suggesting that earlier vaccination with RZV may be a more effective public health policy against HZ. Greater numbers of averted HZ cases and lower NNVs estimated at ideal second dose compliance demonstrated the importance of timely series completion.

Keywords: Herpes zoster; Public health impact; Recombinant zoster vaccine.

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Conflict of interest statement

Declarations. Conflict of Interest: Justin Carrico is employed by/holds financial equities in GSK. Nikolaos Giannelos and Desmond Curran were employed by GSK during the time of the study, and hold financial equities in GSK. Sean Matthews was an independent contractor for GSK during the time of the study. Anthony L. Cunningham reports financial support (medical support and article processing charges) for the submitted study. Anthony L. Cunningham reports consulting fees from GSK, Moderna, Seqirus, AbbVie; payment/honoraria for lectures from GSK, Moderna, Healthed; research grants/fellowship from GSK made to his institution and personal support for attending meetings from GSK and Moderna. The authors declare no other financial and non-financial relationships and activities. Ethics Approval: This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. Owing to this reason an ethics committee approval was not required. The authors confirm that this study was performed in accordance with the ethical standards of the Declaration of Helsinki 1964 and its amendments.

Figures

Fig. 1
Fig. 1
Number of additional HZ cases averted by region and worldwide at incremental uptake of 5%. Pairs in brackets [] denote percentage incremental uptake (5%, 10%, or 15%, respectively) and second dose compliance (70% or 100%). HZ herpes zoster, NorAm Northern America
Fig. 2
Fig. 2
NNVs by region and worldwide at second dose compliance of A 70% and B 100%. NNV number needed to vaccinate, NorAm Northern America, YOA years of age
Fig. 3
Fig. 3
One-way sensitivity analysis of additional HZ cases averted worldwide at 5% incremental uptake1. 1Base-Case Additional HZ Cases Averted = 10,282,663. Selected input parameters were varied by using the high or low value in the uncertainty range for vaccine efficacy and waning, and by ± 10% of the base-case value for HZ incidence. HZ herpes zoster, RZV recombinant zoster vaccine, YOA years of age
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