Clinical Infectious Diseases (CID)
Volume 60 Issue 6 March 15, 2015
http://cid.oxfordjournals.org/content/current

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Editor’s choice: Long-term Persistence of Zoster Vaccine Efficacy
Clin Infect Dis. (2015) 60 (6): 900-909 doi:10.1093/cid/ciu918
Vicki A. Morrison, Gary R. Johnson, Kenneth E. Schmader, Myron J. Levin, Jane H. Zhang, David J. Looney, Robert Betts, Larry Gelb, John C. Guatelli, Ruth Harbecke, Connie Pachucki, Susan Keay, Barbara Menzies, Marie R. Griffin, Carol A. Kauffman, Adriana Marques, John Toney, Kathy Boardman, Shu-Chih Su, Xiaoming Li, Ivan S. F. Chan, Janie Parrino, Paula Annunziato, and Michael N. Oxmanfor the Shingles Prevention Study Group
Abstract
Background.
The Shingles Prevention Study (SPS) demonstrated zoster vaccine efficacy through 4 years postvaccination. A Short-Term Persistence Substudy (STPS) demonstrated persistence of vaccine efficacy for at least 5 years. A Long-Term Persistence Substudy (LTPS) was undertaken to further assess vaccine efficacy in SPS vaccine recipients followed for up to 11 years postvaccination. Study outcomes were assessed for the entire LTPS period and for each year from 7 to 11 years postvaccination.
Methods.
Surveillance, case determination, and follow-up were comparable to those in SPS and STPS. Because SPS placebo recipients were offered zoster vaccine before the LTPS began, there were no unvaccinated controls. Instead, SPS and STPS placebo results were used to model reference placebo groups.
Results.
The LTPS enrolled 6867 SPS vaccine recipients. Compared to SPS, estimated vaccine efficacy in LTPS decreased from 61.1% to 37.3% for the herpes zoster (HZ) burden of illness (BOI), from 66.5% to 35.4% for incidence of postherpetic neuralgia, and from 51.3% to 21.1% for incidence of HZ, and declined for all 3 outcome measures from 7 through 11 years postvaccination. Vaccine efficacy for the HZ BOI was significantly greater than zero through year 10 postvaccination, whereas vaccine efficacy for incidence of HZ was significantly greater than zero only through year 8.
Conclusions.
Estimates of vaccine efficacy decreased over time in the LTPS population compared with modeled control estimates. Statistically significant vaccine efficacy for HZ BOI persisted into year 10 postvaccination, whereas statistically significant vaccine efficacy for incidence of HZ persisted only through year 8.

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Editor’s choice: Editorial Commentary: Waning Efficacy of the Herpes Zoster Vaccine
Richard J. Whitley
Clin Infect Dis. (2015) 60 (6): 910-911 doi:10.1093/cid/ciu922
Extract
In this issue of Clinical Infectious Diseases, Morrison and colleagues report the waning efficacy of the herpes zoster (HZ) vaccine with long-term follow-up [1]. This report is the third that defines efficacy of vaccination. The first clinical trial reported the unequivocal efficacy of vaccination of individuals >60 years of age for burden of illness (BOI), incidence of postherpetic neuralgia (PHN), and incidence of HZ [2]. These 3 endpoints were assessed through 4 years postvaccination. A subsequent follow-up study through 7 years of postvaccination evaluation noted persistence of efficacy with slightly lower evidence of benefit than the original clinical trial [3], albeit not statistically significant. With the report of Morrison et al, we are able to reasonably estimate the efficacy of vaccination through year 10, and to a significantly lesser extent year 11…

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Vaccines Against Malaria
Amed Ouattara and Matthew B. Laurens
Clin Infect Dis. (2015) 60 (6): 930-936 doi:10.1093/cid/ciu954
Abstract
Despite global efforts to control malaria, the illness remains a significant public health threat. Currently, there is no licensed vaccine against malaria, but an efficacious vaccine would represent an important public health tool for successful malaria elimination. Malaria vaccine development continues to be hindered by a poor understanding of antimalarial immunity, a lack of an immune correlate of protection, and the genetic diversity of malaria parasites. Current vaccine development efforts largely target Plasmodium falciparum parasites in the pre-erythrocytic and erythrocytic stages, with some research on transmission-blocking vaccines against asexual stages and vaccines against pregnancy-associated malaria. The leading pre-erythrocytic vaccine candidate is RTS,S, and early results of ongoing Phase 3 testing show overall efficacy of 46% against clinical malaria. The next steps for malaria vaccine development will focus on the design of a product that is efficacious against the highly diverse strains of malaria and the identification of a correlate of protection against disease.