Evidence map›Paper›PMID 30361202›Full record

SynthesisBMJ (Clinical research ed.)2018

Efficacy, effectiveness, and safety of herpes zoster vaccines in adults aged 50 and older: systematic review and network meta-analysis.

Andrea C Tricco, Wasifa Zarin, Roberta Cardoso, Areti-Angeliki Veroniki, Paul A Khan, Vera Nincic, Marco Ghassemi, Rachel Warren, Jane P Sharpe, Andrea V Page and 1 more

Open access · hybridAbstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 71 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
71citing papers in PubMed, 10 pooled it
11.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

71 citing papers in PubMed, 10 syntheses or guidelines pooled it, 150 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Infection risk with JAK inhibitors in dermatoses: a meta-analysis.International journal of dermatology · 2025
    Pooled it
  4. Vaccines for preventing herpes zoster in older adults.The Cochrane database of systematic reviews · 2023
    Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Vaccines for preventing herpes zoster in older adults.The Cochrane database of systematic reviews · 2019
    Pooled it
  10. Pooled it
  11. Trial
  12. Trial
  13. Review
  14. Article
  15. Article
  16. Herpes zoster vaccination and cognitive disorders in older adults.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2026
    Article
  17. Article
  18. Article
  19. Article
  20. Article

11 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 2 institutions in 2 countries.

Andrea C TriccoKnowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria Street, East Building, Toronto, M5B 1W8, ON, Canada triccoa@smh.ca.ORCID http://orcid.org/0000-0002-4114-8971
Wasifa ZarinKnowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria Street, East Building, Toronto, M5B 1W8, ON, Canada.
Roberta CardosoKnowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria Street, East Building, Toronto, M5B 1W8, ON, Canada.
Areti-Angeliki VeronikiKnowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria Street, East Building, Toronto, M5B 1W8, ON, Canada.
Paul A KhanKnowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria Street, East Building, Toronto, M5B 1W8, ON, Canada.
Vera NincicKnowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria Street, East Building, Toronto, M5B 1W8, ON, Canada.
Marco GhassemiKnowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria Street, East Building, Toronto, M5B 1W8, ON, Canada.
Rachel WarrenKnowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria Street, East Building, Toronto, M5B 1W8, ON, Canada.
Jane P SharpeKnowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria Street, East Building, Toronto, M5B 1W8, ON, Canada.
Andrea V PageDivision of Infectious Diseases, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, Toronto, ON, Canada.
Sharon E StrausDepartment of Medicine, University of Toronto, Toronto, ON, Canada.
St. Michael's Hospital · CAMount Sinai Hospital · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo compare the efficacy, effectiveness, and safety of the herpes zoster live attenuated vaccine with the herpes zoster adjuvant recombinant subunit vaccine or placebo for adults aged 50 and older.

designSystematic review with bayesian meta-analysis and network meta-analysis. DATA SOURCES: Medline, Embase, and Cochrane Library (inception to January 2017), grey literature, and reference lists of included studies. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Experimental, quasi-experimental, and observational studies that compared the live attenuated vaccine with the adjuvant recombinant subunit vaccine, placebo, or no vaccine in adults aged 50 and older. Relevant outcomes were incidence of herpes zoster (primary outcome), herpes zoster ophthalmicus, post-herpetic neuralgia, quality of life, adverse events, and death.

results27 studies (22 randomised controlled trials) including 2 044 504 patients, along with 18 companion reports, were included after screening 2037 titles and abstracts, followed by 175 full text articles. Network meta-analysis of five randomised controlled trials found no statistically significant differences between the live attenuated vaccine and placebo for incidence of laboratory confirmed herpes zoster. The adjuvant recombinant subunit vaccine, however, was statistically superior to both the live attenuated vaccine (vaccine efficacy 85%, 95% credible interval 31% to 98%) and placebo (94%, 79% to 98%). Network meta-analysis of 11 randomised controlled trials showed the adjuvant recombinant subunit vaccine to be associated with statistically more adverse events at injection sites than the live attenuated vaccine (relative risk 1.79, 95% credible interval 1.05 to 2.34; risk difference 30%, 95% credible interval 2% to 51%) and placebo (5.63, 3.57 to 7.29 and 53%, 30% to 73%, respectively). Network meta-analysis of nine randomised controlled trials showed the adjuvant recombinant subunit vaccine to be associated with statistically more systemic adverse events than placebo (2.28, 1.45 to 3.65 and 20%, 6% to 40%, respectively).

conclusionsUsing the adjuvant recombinant subunit vaccine might prevent more cases of herpes zoster than using the live attenuated vaccine, but the adjuvant recombinant subunit vaccine also carries a greater risk of adverse events at injection sites. PROTOCOL REGISTRATION: Prospero CRD42017056389.

Indexed as

Adjuvants, ImmunologicAgedFemaleHealth Services for the AgedHerpes ZosterHerpes Zoster VaccineHumansMaleMiddle AgedVaccines, AttenuatedAdjuvants, ImmunologicHerpes Zoster VaccineVaccines, Attenuated

Identifiers

PMID30361202
PMCPMC6201212
OpenAlexW2898577363

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.