Zoster Vaccination and Dementia: Interpreting the Signal and Testing the Mechanisms

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ID: 316413
2026
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Ranked #409 of 531 articles by views in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

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Abstract
Several observational studies and recent natural experiments suggest that herpes zoster vaccination is associated with fewer subsequent dementia diagnoses. Quasi-experimental analyses that exploit date-of-birth eligibility thresholds, largely involving the live attenuated zoster vaccine, strengthen causal inference by reducing confounding from preventive-care behaviors and healthcare utilization; however, they do not establish mechanism or distinguish disease prevention from delayed diagnosis. Three non-mutually exclusive pathways merit direct evaluation: reduced cumulative varicella-zoster virus reactivation burden, including recurrent and possibly unrecognized events; vaccine-induced immune modulation that alters immune aging and inflammatory responses; and neurovascular and neuroinflammatory injury as intermediate pathways linking zoster to later cognitive decline. Priority should now shift to stronger causal designs, pathway-focused analyses of reactivation and vascular intermediates, and prospective studies incorporating longitudinal immune phenotyping and blood-based biomarkers.
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openalex_W7163924162 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Nadine Rouphael
Journal Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Year 2026
DOI
10.1093/cid/ciag358
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