Should we really vaccinate every 65 against the zona every 65?

Is it really appropriate to vaccinate millions of seniors against the zona? The question divides, while the Shingrix vaccine has just been integrated into the French vaccination calendar. Praised for its effectiveness, this vaccine also arouses questions about the relevance of its large -scale generalization. “In a system where resources are constrained, we are surprised to choose a budget so high for a vaccine whose profit in the general population remains quite modest”underlines Rémy Boussageon, President of the Scientific Committee of the National College of Teaching Generalists (CGEN).

Because if Shingrix displays real efficiency, the debate relates less to its intrinsic qualities, than to its real utility … and its cost. This vaccine, which can be administered to immunocompromised people, has shown an effectiveness of 79 % against the zona, and 87 % against chronic pain due to the disease (the famous post-zosteric neuralgia).

Pass advertising

The zona is the reactivation of the chickenpox virus, generally without gravity, but sometimes formidably painful. The rash it causes can be accompanied by burns, and give way, in some cases, to stubborn and disabling chronic pain. Each year 230,000 people are affected. “And the risk increases with age. Before 40 years, there are two cases of zona for 1000 people. At 50, it’s 7 to 8 cases. After 80 years, we go up to 10 cases »specifies Professor Anne-Laure Crémieux, president of the Technical Commission for High Authority for Health (HAS). Immunoscence, in other words, the decline of the age -related immune system, makes older people particularly vulnerable. Result: those over 65 alone represent 72 % of approximately 3,000 annual hospitalizations due to the zona.

It is on this basis that the current vaccination strategy is based: offer Shingrix to all over 65s. “”This decision also aims to simplify the vaccination calendar», Underlines Professor Crémieux. Indeed, from this age are recommended each year the vaccines against covid, flu and pneumococcus and a diphtheria, tetanus, polio.

Read too
Flu, covid, zona, pneumococci … why seniors must be vaccinated

But the CGEN points a gap between this massive deployment and the estimated profit in the general population. “”To avoid a case of zona over 3.7 years, you must vaccinate 34 people. And 293 to prevent post-Zosterian neuralgia ”, insists Professor Rémy Boussageon, citing a study published in the New England Journal of Medicine In 2016. And all for a cost of 320 euros for both doses. Nationally, if the 16 million eligible people received the vaccine, the addition could increase to 6 billion euros over five years. Enough to make counsel the already forced budgets of health.

Anne-Laure Crémieux puts these objections: “Several international studies have shown that zona vaccination could be considered “cost-effective”, if we take into account all the direct and indirect costs of the disease. And it must be kept in mind that few public health interventions are as effective as vaccination, especially in an aging population. WHO itself classifies vaccines among the most cost-effective prevention measures. »»

Be that as it may, vaccination against the zona is not compulsory: it is based on a recommendation, to be discussed with her attending physician. And that’s where everything will be played. The CGEN, skeptical on the collective benefit of this campaign, has also designed a decision -making aid tool to help doctors to assess, on a case -by -case basis, the interest of proposing the vaccine. Its success will therefore depend on the adhesion of the medical profession, but also on the perception of over 65 years. If the reluctance remains for vaccines against influenza and covid, it could be different for the zona. A study published in 2020 in the scientific journal Vaccineconducted in Lyon with 900 people over the age of 65, shows that 69% of them would accept a vaccine if they had risk factors.