Top 5 Takeaways

1. Expanded Indication: The FDA expanded the use of recombinant zoster vaccine (RZV) to include immunocompromised adults aged ≥19 years.
2. ACIP Recommendation: ACIP recommends two doses of RZV for immunocompromised adults to prevent herpes zoster and related complications.
3. Vaccine Efficacy: RZV has shown moderate to high efficacy in preventing herpes zoster in various immunocompromised groups.
4. Safety Profile: The safety profile of RZV is acceptable, with comparable rates of serious adverse events between RZV and placebo recipients.
5. Public Health Impact: RZV has the potential to significantly reduce the incidence and complications of herpes zoster in immunocompromised populations.

Original Article Author and Citation

Corresponding Author

Tara C. Anderson, tcanderson1@cdc.gov

Suggested Citation

Anderson TC, Masters NB, Guo A, et al. Use of Recombinant Zoster Vaccine in Immunocompromised Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:80–84. DOI: http://dx.doi.org/10.15585/mmwr.mm7103a2

Summary

The Advisory Committee on Immunization Practices (ACIP) has recommended the use of recombinant zoster vaccine (RZV) for immunocompromised adults aged ≥19 years. This recommendation follows the FDA’s expanded indication for RZV to include immunocompromised individuals. The vaccine has shown moderate to high efficacy in preventing herpes zoster and its complications and has an acceptable safety profile. This recommendation aims to address the higher incidence and complications of herpes zoster in immunocompromised populations.

Methods

The ACIP Herpes Zoster Work Group reviewed herpes zoster epidemiology and evidence for RZV efficacy and safety in immunocompromised adults through monthly or bimonthly teleconferences. They used the Evidence to Recommendations Framework and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to evaluate benefits and harms associated with RZV. The work group considered critical outcomes like prevention of herpes zoster and serious adverse events (SAEs).

Discussion

The work group found that herpes zoster is a significant public health issue in immunocompromised adults. The desirable effects of RZV, such as preventing herpes zoster and its complications, outweigh the undesirable effects. The vaccine is acceptable to stakeholders and is considered a reasonable and efficient allocation of resources. The recommendation is expected to increase health equity and is feasible to implement. The ACIP unanimously approved the recommendation on October 20, 2021.

Conclusion

RZV has the potential to prevent considerable herpes zoster incidence and related complications in immunocompromised adults aged ≥19 years. The recommendation allows healthcare providers to vaccinate patients at the most appropriate time for their immunocompromising condition or therapy. Continued monitoring and research are essential to guide future recommendations and ensure the vaccine’s safety and efficacy.

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