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The Recombinant Shingles Vaccine Is Associated With a Lower Risk of Dementia
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- This cohort study comparing patients who received the recombinant shingles vaccine with those receiving the live vaccine showed that receiving the recombinant vaccine was associated with a significantly lower risk of dementia than receiving the live vaccine, with a 17% increase in dementia-free time, translating to 164 additional days lived without dementia. This effect persisted after multiple secondary analyses and was present in both men and women, with a greater effect observed in women.
- These findings suggest that the recombinant shingles vaccine could potentially offer additional benefits beyond preventing shingles, prompting further investigation into the relationship between the varicella zoster virus and dementia as well as further evaluation of the preventive benefit of the vaccine via randomized control trials.
abstract
This abstract is available on the publisher's site.
Access this abstract nowThere is emerging evidence that the live herpes zoster (shingles) vaccine might protect against dementia. However, the existing data are limited, and only refer to the live vaccine now discontinued in the USA and many other countries in favour of a recombinant vaccine. Whether the recombinant shingles vaccine protects against dementia remains unknown. Here we used a natural experiment opportunity created by the rapid transition from the use of live to the use of recombinant vaccines to compare the risk of dementia between vaccines. We show that the recombinant vaccine is associated with a significantly lower risk of dementia in the 6 years post-vaccination. Specifically, receiving the recombinant vaccine is associated with a 17% increase in diagnosis-free time, translating into 164 additional days lived without a diagnosis of dementia in those subsequently affected. The recombinant shingles vaccine was also associated with lower risks of dementia compared to two other vaccines commonly used in older people: influenza and tetanus/diphtheria/pertussis vaccines. The effect was robust across multiple secondary analyses, and present in both men and women but greater in women. These findings should stimulate studies investigating the mechanisms underpinning the protection and could facilitate the design of a large-scale randomised control trial to confirm the possible additional benefit of the recombinant shingles vaccine.
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The recombinant shingles vaccine is associated with lower risk of dementia
Nat. Med. 2024 Jul 25;[EPub Ahead of Print], M Taquet, Q Dercon, JA Todd, PJ HarrisonFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Reduced dementia associated with recombinant shingles vaccine
Sometimes simple observational studies can be elegant; it is just a matter of timing. Such is the case with this interesting evaluation of a co-benefit following the administration of the recombinant shingles vaccine (Shingrix®). Prior studies of the live attenuated shingles vaccine (Zostavax®) have suggested a reduction in emergent dementia for individuals receiving the vaccine. The sudden shift from live attenuated shingles vaccine to the adjuvanted recombinant vaccine — following a preferential recommendation from the US Advisory Committee on Immunization Practices in October 20171— created conditions ripe for a “natural experiment.”
Over 100,000 individuals receiving the shingles vaccine between November 2017 and October 2020 were propensity-score matched with the same number of individuals who had received the vaccine between October 2014 and September 2017. Propensity-score matching mimics the statistical properties of a randomized controlled trial by matching individuals in one group with those in another group with similar characteristics. Most (95%) of the latter group received the recombinant shingles vaccine, while 98% of the earlier group received the live attenuated vaccine. This was a nice application of timing. The study’s design also had other nuanced benefits:
Individuals in the group receiving the adjuvanted recombinant vaccine had a 17% reduction in dementia diagnosis in the following 6 years compared with individuals receiving the live attenuated vaccine, with a greater effect observed for women. In addition, the 2017 to 2020 group had a 35% reduction in the risk for shingles. Outcome assessments were for vaccine versus vaccine and not vaccine versus placebo. Keep in mind that recipients of the live attenuated vaccine already appeared to have some protection against dementia compared with non-vaccinated individuals.
We do not know why the shingles vaccine protects one from dementia. The differential immunogenicity of the two vaccines suggests that a linkage exists between this common virus and neurological outcomes. For the clinician, the key points are that the adjuvanted recombinant shingles vaccine is highly effective in preventing shingles and appears to offer additional co-benefits with regard to dementia.
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