Un nouveau vaccin contre le zona recommandé par la Haute autorité de santé (HAS)
Le zona est une dermatose virale fréquente causée par la réactivation du virus de la varicelle et du zona (VZV). On estime qu’environ 25% de la population française, tous âges confondus, pourrait avoir au moins un épisode de zona au cours de la vie. Cette proportion atteint 50% chez les personnes de plus de 80 ans. En 2022, le taux d’incidence annuel du zona dans la population française consultant en médecine générale (réseau sentinelles) était de 346 nouveaux cas de zona pour 100 000 habitants, l’âge médian de survenue du zona étant de 65 ans avec 69% des cas âgés de 50 à 89 ans. Les douleurs post-zostériennes (DPZ), douleurs neuropathiques persistantes au-delà de 3 mois après l’éruption vésiculeuse zostérienne, constituent la principale complication du zona. Le taux d’incidence annuel moyen des cas hospitalisés pour zona est de l’ordre de 4 à 5 cas pour 100 000 habitants ; il est 8 fois supérieur chez les patients âgés de plus de 65 ans comparativement aux patients âgés de moins de 65 ans [1].
Actuellement, la stratégie de prévention du zona et des DPZ repose sur la vaccination par le vaccin vivant atténué (souche vaccinale Oka de VZV, vOka) Zostavax® (laboratoire MSD). En 2013, le Haut conseil de la santé publique (HCSP) a recommandé ce vaccin chez les adultes de 65 à 74 ans révolus, en suivant un schéma à une seule dose, y compris chez ceux ayant déjà présenté un ou plusieurs épisodes de zona. Ce vaccin est contre-indiqué chez les individus immunodéprimés [2]. Malgré ces recommandations, la couverture vaccinale dans cette population reste inférieure à 5% en France. L’Académie de médecine s’était d’ailleurs inquiétée, en novembre 2023, de la faible couverture vaccinale des personnes de plus de 65 ans contre quatre maladies infectieuses parmi les plus sévères pour cette tranche d’âge, dont le zona, et avait jugé que la vaccination des séniors devait devenir un objectif prioritaire de santé publique [3].
Un autre vaccin contre le zona est également disponible en France : le vaccin Shingrix® (laboratoire GSK), un vaccin sous-unitaire recombinant à base de glycoprotéine E du VZV et adjuvanté, utilisé selon un schéma à deux doses. A la différence du vaccin Zostavax®, le vaccin Shingrix® peut être utilisé chez les individus immunodéprimés. Il est actuellement non remboursable et non agréé aux collectivités. La Direction générale de la santé (DGS) avait saisi la HAS le 14 juin 2021 afin de réévaluer la stratégie actuelle de prévention du zona et des DPZ, en matière d’âge et de rappels éventuels, et pour déterminer la place respective des deux vaccins disponibles [4]. Dans son récent rapport du 29 février 2024, la HAS préconise la vaccination contre le zona des adultes immunocompétents de 65 ans et plus, préférentiellement avec le vaccin Shingrix®. Elle recommande également la vaccination contre le zona avec le vaccin Shingrix® des personnes de 18 ans et plus, dont le système immunitaire est défaillant (déficit immunitaire primitif, infection par le virus de l’immunodéficience humaine [HIV], corticothérapie au long cours ou autres traitements immunosuppresseurs) [5]. La HAS indique notamment que le vaccin Shingrix® est supérieur au vaccin Zostavax® en termes d’efficacité vaccinale pour la prévention de l’apparition du zona (79% versus 46%) et des DPZ (87% versus 66%). En proposant la vaccination contre le zona des adultes âgés de 65 ans et plus, la HAS défend un schéma vaccinal simple et lisible, condition nécessaire à l’amélioration de la couverture vaccinale des seniors. En effet, d’autres vaccinations sont recommandées dans cette tranche d’âge : rappel contre la diphtérie, le tétanos et la poliomyélite à 65 ans, vaccination contre la grippe et contre la Covid-19 pour les 65 ans et plus. La HAS précise d’ailleurs que le vaccin Shingrix® peut être administré en même temps que ces autres vaccins.
Espérons donc que ces nouvelles recommandations de la HAS permettent non seulement d’accélérer l’établissement des conditions de remboursement du vaccin Shingrix® par les organismes d’assurance maladie, mais aussi de promouvoir largement son utilisation en routine chez les séniors.
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Réseau sentinelles, Institut Pierre Louis d’épidémiologie et de santé publique. Bilan d’activité 2020. Janvier à décembre 2020. Paris : Faculté de médecine Sorbonne Université ; 2021. https://www.sentiweb.fr/document/5361.
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Haut conseil de la santé publique. Avis du 25 octobre 2013 relatif à la vaccination des adultes contre le zona avec le vaccin Zostavax®. Paris : HCSP ; 2013. https://www.hcsp.fr/explore.cgi/avisrapportsdomaine?clefr=389.
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Académie de médecine. Rapport du 7 novembre 2023 relatif à la vaccination des séniors. Paris ; 2023. https://www.academie-medecine.fr/vaccination-des-seniors.
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Agence européenne des médicaments. Shingrix, poudre et suspension pour suspension injectable. Vaccin zona (recombinant, avec adjuvant). Résumé des caractéristiques du produit. Londres: AEM; 2018. https://www.ema.europa.eu/en/documents/product-information/shingrix-epar-product-information_fr.pdf.
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Haute autorité de santé. Recommandations vaccinales contre le zona. Place du vaccin Shingrix. 29 février 2024. Paris. https://www.has-sante.fr/jcms/p_3499761/fr/la-has-actualise-la-strategie-de-vaccination-contre-le-zona
Dr David BOUTOLLEAU
david.boutolleau@aphp.fr
Responsable du Centre National de Référence Herpèsvirus (laboratoire associé)
Service de Virologie, Hôpital Pitié-Salpêtrière, Groupe Hospitalo-Universitaire (GHU) AP-HP. Sorbonne Université, Paris
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