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ACIP delays vote for younger herpes zoster cohort

Issue: July 2011

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Issues regarding the use of the herpes zoster vaccine among those aged 50 to 59 years remain unresolved as the Advisory Committee on Immunization Practices continues to discuss post-licensure data.

As previously reported in Infectious Disease News, the herpes zoster vaccine (Zostavax, Merck) was recently approved by the FDA for use in adults aged 50 to 59 years and originally licensed in May 2006 for use in adults aged at least 60 years.

“The terms of reference for our working group were to review new data regarding use of zoster vaccine among persons 50 to 59 years of age and to consider revision of the ACIP recommendations; and secondly, to review zoster vaccine post-licensure data. At this point, the group does not propose revisions of existing recommendations regarding zoster vaccine,” Paul R. Cieslak, MD, member of the ACIP herpes zoster vaccine working group, said during the ACIP meeting.

Cieslak summarized some of the key points the working group discussed, including insufficient evidence regarding the duration of vaccine protection. “If we were going to move the vaccination point from 60 years to 50 years, then we would move the vaccination even further before the peak in incidence of zoster.”

Also of concern were vaccine supply issues. “It might be inappropriate to expand recommendations for use of the vaccine while the zoster vaccine remains in such short supply,” Cieslak said. “If we were to talk about a recommendation to vaccinate everybody 50 years of age and older, we might simultaneously be discussing recommendations for prioritization of the vaccine in a time of shortage.”

“For ACIP recommended programs, CDC is ultimately responsible for assuring that they work effectively and correctly, and the ACIP has never adopted an expansion of a vaccination program in the midst of a supply shortage,” Rafael Harpaz, MD, MPH of the CDC, said during the meeting. “It’s hard to make the case to address an expansion in the recommendations for the vaccine to new age groups before sustainable supplies are assured, especially if it might result in more, not less disease.” – by Ashley DeNyse

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