Abstract
Purpose :
Few population-based studies examine the effect of zoster vaccination on rates of herpes zoster ophthalmicus (HZO) and herpes zoster (HZ). The aim of this retrospective time-trend analysis was to examine rates of HZO and HZ in Australia over time, both in the immunocompetent and immunocompromised. We hypothesised HZO and HZ rates would decrease in immunocompetent individuals following the introduction of the live-attenuated zoster vaccine (Zostavax®) on Australia’s National Immunisation Program (NIP) in 2016. The NIP allows 70-79-year-olds to receive Zostavax® for free. The recombinant subunit zoster vaccine (Shingrix®) is not available via Australia’s NIP.
Methods :
We analysed all antiviral prescriptions dispensed for the treatment of HZO and HZ in Australia from 1994 to 2019, as recorded by the Australian Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme. We calculated annual prescription rates to descriptively explore HZO and HZ incidence over time.
Results :
Amongst immunocompetent individuals, rates of HZO and HZ increased 1.90-fold in the period 1998-2015, before decreasing 0.48-fold between 2016-2019 (Figure). Amongst immunocompromised individuals, rates of HZ increased throughout the study period, rising 8.50-fold between 2006 (year data first available) and 2019.
Conclusions :
The introduction of Zostavax® on Australia’s NIP coincided with reduced rates of HZO and HZ in immunocompetent individuals, highlighting the likely beneficial effect of zoster vaccination within the Australian population. Ophthalmologists should remain alert to HZO in immunocompromised patients, whose immune status may be a contraindication to live zoster vaccination, with zoster rates rising amongst the immunocompromised, even after the introduction of Zostavax®.
This is a 2021 ARVO Annual Meeting abstract.