Executive Summary: 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host

Rubin, Lorry G.; Levin, Myron J.; Ljungman, Per; Davies, E. Graham; Avery, Robin K.; Tomblyn, Marcie; Bousvaros, Athos; Dhanireddy, Shireesha; Sung, Lillian; Keyserling, Harry L.; Kang, Insoo

doi:10.1093/cid/cit816

Cited by 824 publications

(392 citation statements)

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“…due to lymphoma, leukemia, cellular immune deficiencies and HIV/AIDS as well as patients on immunosuppressive or immunomodulating therapies [84,117]. This recommendation is based largely upon expert opinion rather than clinical data [118]. It is recognized that patients with moderate immunosuppression, such as those with chronic inflammatory conditions on low-dose corticosteroid therapy either alone or in combination with low-dose non-biological oral immune modulating drugs can receive the vaccine [21,84].…”

Section: Zoster Vaccine – Unresolved Questionsmentioning

confidence: 99%

Varicella and herpes zoster vaccine development: lessons learned

Warren‐Gash

Forbes

Breuer

2017

Expert Review of Vaccines

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Introduction: Before vaccination, varicella zoster virus (VZV), which is endemic worldwide, led to almost universal infection. This neurotropic virus persists lifelong by establishing latency in sensory ganglia, where its reactivation is controlled by VZV-specific T-cell immunity. Lifetime risk of VZV reactivation (zoster) is around 30%. Vaccine development was galvanised by the economic and societal burden of VZV, including debilitating zoster complications that largely affect older individuals. Areas covered: We describe the story of development, licensing and implementation of live attenuated vaccines against varicella and zoster. We consider the complex backdrop of VZV virology, pathogenesis and immune responses in the absence of suitable animal models and examine the changing epidemiology of VZV disease. We review the vaccines’ efficacy, safety, effectiveness and coverage using evidence from trials, observational studies from large routine health datasets and clinical post-marketing surveillance studies and outline newer developments in subunit and inactivated vaccines. Expert commentary: Safe and effective, varicella and zoster vaccines have already made major inroads into reducing the burden of VZV disease globally. As these live vaccines have the potential to reactivate and cause clinical disease, developing alternatives that do not establish latency is an attractive prospect but will require better understanding of latency mechanisms.

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Section: Zoster Vaccine – Unresolved Questionsmentioning

confidence: 99%

Varicella and herpes zoster vaccine development: lessons learned

Warren‐Gash

Forbes

Breuer

2017

Expert Review of Vaccines

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“…In HIV-infected patients, the immunogenicity of vaccines is reduced when HIV replication is not controlled by antiretroviral treatment and/or when the CD4 count is below 500/mm 3 , and even more below 200/mm 3 . Moreover, the duration of seroprotection is shorter than in non-immunocompromised individuals and may necessitate more frequent boosters.…”

Section: General Principlesmentioning

confidence: 99%

“…However, live attenuated vaccines are contraindicated in patients with severe immunodeficiency (CD4 count lower than 200/mm 3 ).…”

Section: General Principlesmentioning

confidence: 99%

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Immunization of HIV-infected adult patients — French recommendations

Frésard

Gagneux‐Brunon

Lucht

et al. 2016

Human Vaccines & Immunotherapeutics

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Human immunodeficiency virus (HIV)-infected patients remain at increased risk of infection including vaccine-preventable diseases. Vaccines are therefore critical components in the protection of HIV-infected patients from an increasing number of preventable diseases. However, missed opportunities for vaccination among HIV-infected patients persist and vaccine coverage in this population could be improved. This article presents the French recommendations regarding immunization of HIV-infected adults in the light of the evidence-based literature on the benefits and the potential risks of vaccines among this vulnerable population.

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“…Zoster vaccination should be offered to 60 year-old patients who are receiving treatment that induces a low level of immunosuppression (strength of recommendation and level of evidence: strong, low); it should not be administered to highly immunocompromised patients (strength of recommendation and level of evidence: strong, very low). 64 SCP reports that, in a randomized, double-blind, placebo-controlled study, the vaccine was administered to 206 >60 year-old subjects who were receiving systemic chronic corticosteroid maintenance therapy, equivalent to a daily dose of 5-20 mg of prednisone, for at least 2 weeks prior to enrollment, and 6 weeks or more after vaccination to assess the immunogenicity and safety profile. Compared with placebo, the vaccine induced a higher geometric mean titer (GMT) of VZV-specific Abs by gpELISA (VZV glycoprotein-based enzyme-linked immunosorbent assay) 6 weeks after vaccination (531.1 vs. 224.3 gpELISA units/ml, respectively).…”

Section: Can Zoster Vaccine Be Co-administered To Other Vaccines?mentioning

confidence: 99%

Prevention of Herpes Zoster and its complications: From clinical evidence to real life experience

Gabutti

Bonanni

Conversano³

et al. 2016

Human Vaccines & Immunotherapeutics

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Herpes zoster (HZ) is an acute viral illness characterized by a vesicular rash with unilateral distribution, which can also result in severe complications such as post-herpetic neuralgia (PHN), ophthalmic zoster, stroke or other neurological complications. The estimate incidence in Europe ranges between 2.0 and 4.6 cases per 1,000 person-years, with a sharp increase in >50 year-old subjects. Currently, treatment options for HZ are only partially effective in limiting the acute phase, while the management of complications is complex and often unsatisfactory. The total burden of the disease and the high costs related to its diagnostic and therapeutic management led researchers to develop a new preventive approach through a live attenuated virus vaccine. The currently available vaccine, with a high antigen content, is safe, well tolerated and reduces the incidence of HZ, PHN and the burden of illness. Several countries have introduced this vaccination, albeit with different recommendations and methods of financing. Taking into account the barriers to this immunization registered in some areas (difficulty of vaccine distribution, lack of physician recommendations, the cost of vaccine for patients, etc.), this group of Italian experts advocate that a common strategy able to guarantee a good compliance with this vaccination should be implemented. The same group addresses some practical questions concerning the use of zoster vaccine.

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Executive Summary: 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host

Cited by 824 publications

References 0 publications

Varicella and herpes zoster vaccine development: lessons learned

Varicella and herpes zoster vaccine development: lessons learned

Immunization of HIV-infected adult patients — French recommendations

Prevention of Herpes Zoster and its complications: From clinical evidence to real life experience

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