Expansion Of Vaccine Programme Needed To Support NZ’s Ageing Population - Research

Vaccine programmes may need to be expanded to protect older Kiwis, Māori and the immunocompromised against a potentially debilitating disease, according to a population health academic.

The call comes as new research into the shingles virus shows that New Zealand’s population may become increasingly vulnerable to the disease as they age.1 8 11 14

Shingles is a viral infection caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox. Even those who appear healthy but are aged 50 plus are at risk of developing shingles.2

Almost all adults aged over 50 already have the virus that causes shingles in their bodies due to an initial chickenpox infection. Around a third of these will develop shingles in their lifetime when the virus reactivates.2

The shingles rash or blisters occurs on one side of the body, most commonly the torso but the disease can affect other areas such as the face and scalp. Shingles can be intensely painful and can impact sleep and being able to do daily activities. Some people may go on to develop complications, which include long lasting nerve pain, vision and hearing loss, scarring and neurological problems, and rarely cardiovascular and stroke events.[3][4][5]

Professor of Population Health at Victoria University of Wellington, Colin Simpson, says new research suggests there may be a need to expand our current vaccination model to adapt to our ageing population.[6][7]8 9

The number of Kiwis aged 85+ is expected to grow by 115% to 200,000 by 2040 - a demographic shift from one in 50 to around one in every 20 New Zealanders, therefore there is a need to keep people healthy for longer.8

He says with our ageing population and high prevalence of chronic diseases that can compromise the immune system, particularly among Maori, we may need to expand the immunisation programme for shingles prevention. 8 14

“The risk of shingles tends to increase with age, however as we get older, our immunity weakens, and it becomes harder to sustain vaccine effectiveness. 6 8 12 15

“This has repercussions for New Zealand’s ageing population who are living longer and expected to grow significantly in number.

“We need to start looking at research programmes now to investigate vaccine effectiveness and safety, and vaccine uptake amongst different groups within the New Zealand population," he says.

Dr James Mbinta, Research Fellow at Victoria University of Wellington School of Health, says other vulnerable groups in our population include those living with chronic diseases whose immune systems may be compromised.10

“Pre-existing diseases of the kidney, heart and autoimmune system may trigger a resurgence of the shingles virus within the body, even among younger age groups.9

“We know that Maori have higher rates of some chronic diseases, and research is needed to evaluate the vaccine effectiveness against shingles and severe outcomes over time in people with these conditions.10

“The complications include postherpetic neuralgia (PHN) which can cause excruciating and continuous nerve pain and impact around a third of people with shingles lasting in some cases for years”, he says.11 16

Brett Marett, Medical Director at GSK NZ says two doses of the vaccine for shingles, Shingrix, are funded for those aged 65, and GSK NZ has also made the vaccine available for private purchase for other at-risk groups.

He says it is also recommended but not funded for use from age 50 years. Pharmac is currently consulting on a proposal to fund a group of individuals aged 18 years or older with increased risk of shingles due to immunocompromise.12 17

In contrast, the Australian Government recently launched a more extensive funding programme for shingles. It is understood to be one of the most comprehensive and widely available shingles vaccine programmes in the world with the vaccine funded and free to anyone aged 65+; First Nations people 50+ and immunocompromised people 18 years and over at high risk of shingles infection.18

[1] Klein, N. P., Bartlett, J., Fireman, B., Marks, M. A., Hansen, J., Lewis, E., Aukes, L., & Saddier, P. (2023, November 8). Effectiveness of the live zoster vaccine during the 10 years following vaccination: real world cohort study using electronic health records. BMJ, e076321. https://doi.org/10.1136/bmj-2023-076321. Accessible here.

[2] Centers for Disease Control and Prevention. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2008 May;57(RR-5):1-30.

[3] Cohen KR, Salbu RL, Frank J, Israel I. Presentation and management of herpes zoster (shingles) in the geriatric population. P T. 2013;38(4):217-227. Accessible here.

[4] Niederer RL, Meyer JJ, Liu K, Danesh-Meyer HV. Herpes Zoster Ophthalmicus Clinical Presentation and Risk Factors for Loss of Vision. Am J Ophthalmol. 2021;226:83-89. doi:10.1016/j.ajo.2021.02.002Herpes Zoster Ophthalmicus Clinical Presentation and Risk Factors for Loss of Vision - PubMed (nih.gov)

[5] Erskine N, Tran H, Levin L, et al. A systematic review and meta-analysis on herpes zoster and the risk of cardiac and cerebrovascular events. PLoS One. 2017;12(7):e0181565. Published 2017 Jul 27. doi:10.1371/journal.pone.0181565. Accessible here.

[6] Klein, N. P., Bartlett, J., Fireman, B., Marks, M. A., Hansen, J., Lewis, E., Aukes, L., & Saddier, P. (2023, November 8). Effectiveness of the live zoster vaccine during the 10 years following vaccination: real world cohort study using electronic health records. BMJ, e076321. https://doi.org/10.1136/bmj-2023-076321. Accessible here.

[7] Mbinta, J. F., & Simpson, C. R. (2023, November 8). Long term effectiveness of live herpes zoster vaccine. BMJ, p2497. https://doi.org/10.1136/bmj.p2497

[8] Stats New Zealand One million people aged 65+ by 2028 | Stats NZ.

[9] Marra et al. 2020 Risk Factors for Herpes Zoster Infection: A Meta-Analysis - PubMed (nih.gov).

[10] Tatau Kahukura: Maori Health Chart Book 2015 Accessible here.

11 Editorial: Long term effectiveness of live herpes zoster vaccine. Accessible here.

12 Turner NM, MacRae J, Nowlan ML, McBain L, Stubbe MH, Dowell A. Quantifying the incidence and burden of herpes zoster in New Zealand general practice: a retrospective cohort study using a natural language processing software inference algorithm. BMJ Open. 2018;8(5) [PMC free article] [PubMed] [Google Scholar]

142022-05-Immunisation-Advisory-Committee-Record.pdf (pharmac.govt.nz)

15 Kawai K, Gebremeskel BG, Acosta CJ. Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open. 2014;4(6):e004833. Published 2014 Jun 10. doi:10.1136/bmjopen-2014-004833

16Centers for Disease Control and Prevention. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2008 May;57(RR-5):1-30.

17Ministry of Health: Immunisation Handbook 2022. Accessible here.

18 Australian Department of Health and Aged Care. Accessible here

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