In a pivotal study published by BMJ Open, researchers have unveiled the considerable public health benefits of incorporating an adjuvanted recombinant zoster vaccine (RZV) into the United Kingdom’s universal mass vaccination programme. The herpes zoster immunisation programme, established in the UK in 2013, initially recommended the then sole option, a zoster vaccine live (ZVL), for adults aged 70. Recent advancements, however, have seen the approval of the RZV, with a clinical profile suggesting superior benefits.

The Study

Published on May 5, 2019, and conducted by a team of experts (van Oorschot et al.), this research stands as a significant evaluation comparing the currently recommended ZVL with the newly introduced RZV. Utilising a previously developed health economic model adapted to the UK context, the study estimated the potential public health impact (PHI) of vaccinating individuals with RZV instead of ZVL.

Clinical trials efficacy data fuelled the model, with herpes zoster (HZ) incidence and postherpetic neuralgia (PHN) probability figures drawn from a previous UK study. Additionally, HZ-associated complication rates were incorporated from published literature. The base-case scenario focused on a projected 2018 vaccination cohort of 70-year-old individuals, assuming a 48.3% first-dose coverage for both vaccines and a 70% compliance rate for RZV’s second dose.

Key Results

The estimated outcomes were striking. RZV stands to reduce the number of HZ cases by 30,262 and PHN cases by 5,409 when compared to no vaccination. In contrast, ZVL would result in 7,909 fewer HZ cases and a reduction of 3,567 PHN cases. The number needed to vaccinate to prevent one case of HZ is significantly lower for RZV (12) than for ZVL (45), clearly demonstrating the former’s greater efficacy.

Moreover, the research indicated that the highest PHI would be seen if the vaccination was administered at 60 or 65 years of age, suggesting the potential for adjusting age recommendations. The robustness of these results was confirmed through various scenario and sensitivity analyses.

Implications and Future Policy

This study’s findings depict a potential shift in the UK’s approach to herpes zoster vaccination, with RZV proving to be a more effective strategy against HZ and PHN. The tangible decrease in healthcare resources usage and the number of cases prevented mark an opportunity to significantly enhance public health outcomes.

1. Health Policy Implications: Evaluating and potentially revising the current age group targeted by the herpes zoster vaccination programme could lead to greater PHI and a reduction in the burden on the healthcare system.

2. Resource Utilization: A reduced number of HZ and PHN cases may translate into fewer hospital admissions, outpatient visits, and medication needs, thereby alleviating the load on healthcare resources.

3. Age Optimization for Vaccination: Considering a lower age for vaccine administration might be beneficial, as suggested by the model’s prediction of peak PHI achieved with vaccination at age 60 or 65.

4. Long-term Benefits: With projections calculated over a lifetime horizon, the impact alignment of RZV extends beyond immediate prevention, contributing to prolonged public health advantages.

5. Vaccination Compliance: Compliance with the second dose of RZV remains a crucial factor. Policies promoting full vaccination compliance are necessitated to attain the projected PHI benefits.

Published under the Creative Commons Attribution Non-Commercial (CC BY-NC) license, the study by van Oorschot et al. is accessible for further review and research, augmenting the scope of knowledge surrounding adult vaccination practices.


Incorporating RZV into the UK’s vaccination protocol presents an opportunity to significantly reduce the incidence and complications of herpes zoster, underscoring the importance of public health-driven vaccination strategies. As stakeholders reconvene to consider these findings, the potential reshaping of herpes zoster immunisation remains a promising venture in the constant pursuit of enhanced healthcare outcomes.

DOI: 10.1136/bmjopen-2018-025553


Van Oorschot DAM, Hunjan M, Bracke B, Lorenc S, Curran D, Starkie-Camejo H. (2019 May 05). Public health impact model estimating the impact of introducing an adjuvanted recombinant zoster vaccine into the UK universal mass vaccination programme. BMJ Open, 9(5), e025553. DOI:10.1136/bmjopen-2018-025553


1. Herpes Zoster Vaccine UK
2. Adjuvanted Recombinant Zoster Vaccine
3. Shingles Vaccination Age
4. Zoster Vaccine Live Efficacy
5. Herpes Zoster Public Health Impact