Condition

Varicella and herpes zoster

Clinical trials and treatment information for Varicella and herpes zoster

5.3M
People Affected
50
Active Trials
1.6M
New Cases/Year
14K
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Zoster Vaccine, Recombinant, Adjuvanted (Shingrix)
95% Effectiveness• 98% Confidence• 85% Safety• 9 trials• 40K participants
HIGH EvidenceExcellent ValueDose: 0.5 mL IM, 2 doses 2-6 months apart
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Comparative Safety Scale(Higher is safer)

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85
DangerousModerateSafe

Time to Effect

1 month after second dose

Duration

Two-dose series, protection >10 years

Response Rate

%

Remission Rate

%

Number Needed to Treat (NNT)

10

Number Needed to Harm (NNH)

100000

Common Side Effects:

Injection site pain: 80%
Myalgia: 40%
Fatigue: 40%
Headache: 35%
Fever: 20%

Annual Cost of Care

Drug Cost

$320

Monitoring

$100

Side Effects

$5

Total Annual

$42.5

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.057

ICER

$24,000/QALY

Treatment Outcomes
Primary Outcomes
Incidence of Herpes Zoster9.1 cases per 1,000 person-years (in unvaccinated adults ≥50)
-91.3% (-8.3 cases per 1,000 person-years)
Incidence of Post-Herpetic Neuralgia (PHN)Estimated 1.4 cases per 1,000 person-years (overall PHN risk in unvaccinated adults ≥50)
-88.8% (-1.2 cases per 1,000 person-years)
Incidence of severe HZ-related pain (MZPS ≥ 7)Estimated 3.0 cases per 1,000 person-years (in unvaccinated adults ≥50)
-90% (-2.7 cases per 1,000 person-years)
Secondary Benefits
Overall burden of Herpes Zoster diseaseAverage HZ Burden of Illness (BOI) score: 4.5 points (unvaccinated adults ≥50, higher score indicates worse burden)
-90% (-4.05 points on HZ Burden of Illness score)
HZ-related healthcare visits (physician, emergency department, hospitalization)0.2 HZ-related healthcare visits per person-year (in unvaccinated adults ≥50)
-90% (-0.18 visits per person-year)
Common Side Effects
Injection site pain
+80%
Myalgia
+40%
Fatigue
+40%

Clinical Trial Phases:

Phase 4
2
Varicella Vaccine (Chickenpox Vaccine)
90% Effectiveness• 95% Confidence• 85% Safety• 188 trials• 100K participants
HIGH EvidenceExcellent ValueDose: 0.5 mL SC, 2 doses (12-15 months, 4-6 years)
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Comparative Safety Scale(Higher is safer)

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Meth💀
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Morphine💊
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85
DangerousModerateSafe

Time to Effect

2-4 weeks after first dose

Duration

Two-dose series, lifelong protection

Response Rate

%

Remission Rate

%

Number Needed to Treat (NNT)

12

Number Needed to Harm (NNH)

100000

Common Side Effects:

Injection site pain/redness: 20%
Fever: 15%
Mild rash: 5%

Annual Cost of Care

Drug Cost

$300

Monitoring

$100

Side Effects

$5

Total Annual

$8.1

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.004

ICER

$45,000/QALY

Treatment Outcomes
Primary Outcomes
Incidence of Varicella InfectionExpected annual incidence in unvaccinated children: 50 cases per 1000 children
-85% (-42.5 cases per 1000 children annually)
Incidence of Severe VaricellaExpected annual incidence of severe Varicella in unvaccinated children: 5 cases per 1000 children
-98% (-4.9 cases per 1000 children annually)
Herpes Zoster Incidence in ChildhoodAnnual HZ incidence in children after natural Varicella: 2.14 cases per 1000 person-years
-64% (-1.37 cases per 1000 person-years)
Varicella-related Hospitalization RateExpected annual hospitalization rate for Varicella in unvaccinated children: 0.5 per 1000 children
-90% (-0.45 hospitalizations per 1000 children annually)
Secondary Benefits
Varicella-related Healthcare Provider VisitsAverage annual visits for Varicella in unvaccinated children: 100 visits per 1000 children
-80% (-80 visits per 1000 children annually)
Varicella-related School/Work Days LostAverage total school/work days lost due to Varicella in unvaccinated population: 250 days per 1000 children annually
-85% (-212.5 days per 1000 children annually)
Antibiotic Prescriptions for Varicella ComplicationsAnnual antibiotic prescription rate for Varicella complications in unvaccinated children: 10 prescriptions per 1000 children
-85% (-8.5 prescriptions per 1000 children annually)
Common Side Effects
Injection site pain/redness
+20%
Fever
+15%
Mild rash
+5%

Clinical Trial Phases:

Phase 4
3
Valacyclovir
88% Effectiveness• 90% Confidence• 68% Safety• 13 trials• 20K participants
HIGH EvidenceGood ValueDose: 1000mg three times daily for 7 days
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
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Alcohol🍺
Morphine💊
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Water💧
68
DangerousModerateSafe

Time to Effect

24-48 hours

Duration

7 days

Response Rate

75%

Remission Rate

90%

Number Needed to Treat (NNT)

12

Number Needed to Harm (NNH)

1000

Common Side Effects:

Nausea: 15%
Headache: 15%
Abdominal pain: 6%
Diarrhea: 5%

Annual Cost of Care

Drug Cost

$40

Monitoring

$100

Side Effects

$10

Total Annual

$150

Cost-Effectiveness

GOOD

QALYs Gained

0.04

Cost per Remission

$167

Cost per Responder

$200

Treatment Outcomes
Primary Outcomes
Time to Full Crusting of Lesions (Varicella/Zoster)6.5 days
-23.1% (-1.5 days)
Duration of Zoster-Associated Pain (acute)28.0 days
-25% (-7.0 days)
Time to First Zoster-Associated Pain Relief5.0 days
-20% (-1.0 day)
Duration of Viral Shedding (Varicella-Zoster Virus)7.0 days
-42.9% (-3.0 days)
Secondary Benefits
Incidence of Post-Herpetic Neuralgia (>90 days)15% of patients
-40% (-6 percentage points)
Severity of Acute Zoster Pain (NRS 0-10 scale)7.2 points
-16.7% (-1.2 points)
Time to Return to Normal Daily Activities21 days
-23.8% (-5.0 days)
Common Side Effects
Nausea
+15%
Headache
+15%
Abdominal pain
+6%

Clinical Trial Phases:

Phase 4
4
Famciclovir
86% Effectiveness• 90% Confidence• 68% Safety• 5 trials• 10K participants
HIGH EvidenceGood ValueDose: 500mg three times daily for 7 days
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
68
DangerousModerateSafe

Time to Effect

24-48 hours

Duration

7 days

Response Rate

75%

Remission Rate

90%

Number Needed to Treat (NNT)

12

Number Needed to Harm (NNH)

1000

Common Side Effects:

Headache: 15%
Nausea: 10%
Diarrhea: 5%

Annual Cost of Care

Drug Cost

$50

Monitoring

$100

Side Effects

$10

Total Annual

$160

Cost-Effectiveness

GOOD

QALYs Gained

0.04

Cost per Remission

$178

Cost per Responder

$213

Treatment Outcomes
Primary Outcomes
Time to full crusting of lesionsMedian 7.0 days
-28.57% (-2.0 days)
Time to 50% resolution of zoster-associated painMedian 30.0 days
-33.33% (-10.0 days)
Peak pain severity (NRS 0-10) during acute phaseNRS score: 7.5/10
-24% (-1.8 points)
Secondary Benefits
Incidence of Postherpetic Neuralgia (PHN) at 6 months20.0% of patients
-45% (-9.0 percentage points)
Time to return to normal daily activitiesMedian 30.0 days
-23.33% (-7.0 days)
Duration of analgesic useMedian 25.0 days
-32% (-8.0 days)
Common Side Effects
Headache
+15%
Nausea
+10%
Diarrhea
+5%

Clinical Trial Phases:

Phase 4
5
Acyclovir
85% Effectiveness• 95% Confidence• 68% Safety• 17 trials• 30K participants
HIGH EvidenceExcellent ValueDose: 800mg five times daily for 7-10 days
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
68
DangerousModerateSafe

Time to Effect

24-48 hours

Duration

7-10 days

Response Rate

70%

Remission Rate

88%

Number Needed to Treat (NNT)

15

Number Needed to Harm (NNH)

1000

Common Side Effects:

Nausea: 10%
Headache: 10%
Vomiting: 5%
Diarrhea: 3%

Annual Cost of Care

Drug Cost

$30

Monitoring

$100

Side Effects

$10

Total Annual

$140

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.03

Cost per Remission

$159

Cost per Responder

$200

Treatment Outcomes
Primary Outcomes
Time to full crusting of lesions7.5 days
-20% (-1.5 days)
Duration of acute pain40 days
-25% (-10 days)
Time to cessation of new lesion formation3 days
-33% (-1 day)
Maximum number of lesions300 lesions
-20% (-60 lesions)
Secondary Benefits
Duration of pruritus5 days
-20% (-1 day)
Risk of Postherpetic Neuralgia (PHN)20% incidence
-15% (-3% absolute risk)
Severity of systemic symptoms (e.g., malaise, fatigue)6/10 on NRS
-25% (-1.5 points)
Common Side Effects
Nausea
+10%
Headache
+10%
Vomiting
+5%

Clinical Trial Phases:

Phase 4