Public Health Impact of Herpes Zoster in Adults Aged 80 Years or Older in the United Kingdom

Herpes zoster (HZ) results from the reactivation of latent varicella zoster virus, acquired earlier in life. The risk of post-herpetic neuralgia (PHN), the most frequent HZ complication, increases with age. In 2024, the Joint Committee on Vaccination and Immunisation extended its recommendation of the recombinant zoster vaccine (RZV) for inclusion in the United Kingdom (UK) National Immunisation Programme to adults aged ≥80 years. In this study, we evaluate the potential public health impact of RZV introduction in adults aged ≥80 years.

The ZOster ecoNomic Analysis (ZONA) model was adapted to the UK setting using HZ prevalence, HZ incidence, PHN, and HZ‑related healthcare resource use data from the Clinical Practice Research Datalink (2012–2019). Initial two‑dose RZV efficacy and annual waning rates were taken from 11‑year follow‑up of the ZOE‑50/70 studies. Due to RZV coverage for the ≥80 cohort being unknown, we modelled two coverage scenarios: the first based on first‑year RZV coverage for the 70-year cohort (1st dose: 46.4%, 2nd dose: 30.6%) and the second informed by first year coverage of the live zoster vaccine (1st dose: 61.8%, 2nd dose: 80% [assumed]). Outcomes were compared between hypothetical vaccinated and non‑vaccinated cohorts over their remaining lifetime and included number of HZ cases, PHN cases, hospitalisations, general practitioner (GP) visits, and outpatient consultations.

In the first scenario, vaccination avoided 59,220 HZ cases and 21,133 PHN cases; in the second scenario the numbers rose to 107,150 HZ cases and 38,238 PHN cases avoided. Corresponding reductions in healthcare resource use were: 185,135 and 334,976 GP visits, 45,112 and 81,624 outpatient consultations, and 7,659 and 13,858 hospitalisations for the first and second scenarios, respectively.

Introduction of RZV for adults aged ≥80 years could substantially reduce HZ‑related disease burden and associated healthcare resource use in the UK, with higher coverage yielding greater public health benefits.