With the understanding that efficacy of the live-attenuated herpes zoster (HZ) vaccine (ZVL) wanes significantly over time, a study looked at the immunogenicity and safety of the adjuvanted recombinant zoster vaccine (RZV) in older adults who previously received ZVL.

The report in the Journal of Infectious Diseases focused on 215 adults aged 65 years and older who had been vaccinated with ZVL 5 or more years earlier. Kaiser Permanente and industry researchers matched these patients with 215 ZVL-naïve individuals. All were vaccinated with RZV, and the study team assessed glycoprotein E (gE)-specific humoral and cell-mediated immune (CMI) responses and the correlation between them, polyfunctional gE-specific CD4 T-cell responses, safety, and confirmed HZ cases.

The results indicate that, through 12 months postdose 2, anti-gE antibody concentrations, gE-specific CD4 T-cell frequencies, and activation marker profiles were similar between groups. Safety outcomes were also similar. The researchers add that no HZ episodes were confirmed.

“RZV induced strong humoral and polyfunctional CMI responses that persisted above pre-vaccination levels through 1-year post-dose 2 in adults aged ≥65 years irrespective of previous ZVL vaccination,” the authors conclude. “RZV’s safety profile was not impacted either.”

The CDC recommends the RZV, Shingrix, ZVL, marketed as Zostavax, for the prevention of HZ and related complications. The CDC recommends two doses of Shingrix separated by 2 to 6  months for immunocompetent adults aged 50 years and older, whether or not they report a prior episode of HZ or have received a prior dose of Zostavax.

The RZV also is urged for patients who have chronic medical conditions (e.g., chronic renal failure, diabetes mellitus, rheumatoid arthritis, chronic pulmonary disease), unless a contraindication or precaution exists. Both vaccines also are considered safe for patients taking low-dose immunosuppressive therapy, who are anticipating immunosuppression, or have recovered from an immunocompromising illness.

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