Work

Evidence for non-specific effects of live Shingles vaccination against all-cause death and hospitalisation in older adults in England: a population-based cohort study

Year: 2025

Type: preprint

Abstract: Background Non-specific live vaccine effects have been described in paediatric populations. We investigated whether non-specific effects are observed in older adults with live shingles ( Zostavax® ) immunisation. Methods A population-based cohort study was performed using health records from the Clinical Practice Research Datalink in England. Shingles vaccine eligible individuals aged 70 years and over who had received pneumococcal immunisation were included. All-cause death, all-cause hospitalisation, and infection-associated hospitalisation rates were compared between live shingles vaccinated and unvaccinated person-time using time-to-event and time-to-subsequent-event Cox regression with Andersen-Gill extension. Live shingles vaccine exposure was included as a time-varying exposure. The models were run on an overlap-weighted pseudo-population to minimise confounding. Results Between September 2013 and June 2019 314,618 participants aged 70 years and over who had received pneumococcal immunisation prior to study entry were identified, of which 55% had live shingles vaccine exposure. The overlap-weighted pseudo-population consisted of 60021 lives shingles vaccine unexposed and 60245.6 exposed participants. Live shingles vaccine exposure in the overlap-weighted pseudo-population was associated with a reduction in all-cause death (hazard ratio 0.64; 95% confidence interval 0.62, 0.66), a reduction in subsequent all-cause hospitalisation (hazard ratio 0.84 (0.81, 0.88)), and a reduction in first and subsequent infection-associated hospitalisation (hazard ratio for first event 0.81 (0.79, 0.83), and for subsequent events 0.75 (0.73, 0.77)). Conclusions Receipt of live shingles vaccine associates with lower mortality and morbidity in older adults in England. The potential for causal linkage should be validated in robust prospective studies, with major implications for national immunisation policies. Summary This cohort study finds live shingles vaccine exposure in older adults associates with reduced morbidity and mortality beyond disease-specific protection, which was not explained by measurable confounding. If validated, this has major implications for vaccine choice in national immunisation policies.

Source: medRxiv

DOI: 10.1101/2025.10.16.25338145