Shingles Vaccine Effective Against Herpes Zoster Ophthalmicus

A senior pharmacy customer is grimacing as a gloved pharmacist gives her a flu shot in the upper arm. There are shelves in the background.
Investigators examine the effectiveness of the recombinant vaccine for preventing ocular presentation of the disease.

The herpes zoster vaccine is highly effective in preventing herpes zoster ophthalmicus (HZO) in patients aged 50 years and older, according to researchers. However, their study’s low vaccination rate reveals a need to increase herpes zoster vaccination. The findings have been published in Ophthalmology.

The study shows 1 in 3 Americans will develop herpes zoster during their lifetime, according to researchers. HZO develops in 10% to 20% of herpes zoster cases. Because of the significant morbidity and decreased quality of life associated with HZO, prevention is essential.

Through a retrospective, observational cohort study, researchers examined the effectiveness of the recombinant zoster vaccine in preventing HZO in the general US population. The study included patients who were age-eligible to receive the herpes zoster vaccine (≥50 years old) between 2018 and 2019. 

Patients were required to have at least 365 days of continuous enrollment to be eligible for the study. Those with a diagnosis code of herpes zoster or an immunocompromising condition within 1 year prior to the study were excluded. Receipt of the recombinant zoster vaccine was verified via CPT codes, and diagnoses of HZO were determined through ICD-10 codes. As such, 4,842,579 patients were included in the study.

Of those enrolled, 177,289 (3.7%) received 2 valid doses of recombinant zoster vaccine. The incidence rate of HZO was 25.5 cases per 100,000 person-years (95% CI: 17.4, 35.8) in the vaccinated group compared with 76.7 (95% CI: 74.7, 78.7) in the unvaccinated group. The overall adjusted effectiveness of the vaccine against HZO was 89.1% (95% CI: 82.9, 93.0).

The American Academy of Ophthalmology (AAO) published a policy statement encouraging ophthalmologists to strongly recommend recombinant zoster vaccination in patients aged 50 and older without contraindications. Investigators conclude that ophthalmologists can play a key role in improving vaccination rates by recommending vaccination to their eligible patients.

The study’s authors note several limitations to their research, including that its retrospective design is limited by the quality of ICD coding. Generalizability of this research is limited, since only patients with commercial insurance, Medicare Part D, and

Medicare Advantage were included. Because study participants weren’t randomized, the unvaccinated and vaccinated cohorts had different characteristics. For example, vaccinated patients were more likely to be older and sicker, resulting in a higher risk of developing zoster. Also, the study only excluded patients with a diagnosis of herpes zoster or HZO up to a year before the index date, so those with a more remote history of herpes zoster or HZO may have unintentionally been included in this study. Another limitation is that since HZO is a rare outcome and our study period is limited to two years, some subgroups have larger confidence intervals or couldn’t estimate confidence intervals. In addition, this study could not assess the waning of vaccine effectiveness since the vaccine was only introduced in late 2017, and participants had relatively short post-vaccination follow-up time. Lastly, the vaccine’s effectiveness in patients with a history of HZO can’t be determined since they were excluded from the study.

Disclosure: This research was supported by OptumLabs Warehouse and other entities. Please see the original reference for a full list of disclosures.


Lu A, Sun Y, Porco TC, et al. Effectiveness of the recombinant zoster vaccine for herpes zoster ophthalmicus in the United States. Ophthalmol. Published online April 19, 2021. doi:10.1016/j.ophtha.2021.04.017