Recombinant Adjuvanted Zoster Vaccine and Reduced Risk of Coronavirus Disease 2019 Diagnosis and Hospitalization in Older Adults

Abstract

Background Some vaccines elicit non-specific immune responses that may protect against heterologous infections. We evaluated the association between recombinant adjuvanted zoster vaccine (RZV) and COVID-19 outcomes at Kaiser Permanente Southern California. Methods In a cohort design, adults aged ≥50 years who received ≥1 RZV dose before 3/1/2020 were matched 1:2 to unvaccinated individuals and followed until 12/31/2020. Adjusted hazard ratios (aHR) and 95% confidence intervals (CIs) for COVID-19 outcomes were estimated using Cox proportional hazards regression. In a test-negative design, cases had a positive SARS-CoV-2 test and controls had only negative tests, during 3/1/2020-12/31/2020. Adjusted odds ratios (aOR) and 95% CIs for RZV receipt were estimated using logistic regression. Results In the cohort design, 149,244 RZV recipients were matched to 298,488 unvaccinated individuals. The aHRs (95% CI) for COVID-19 diagnosis and hospitalization were 0.84 (0.81-0.87) and 0.68 (0.64-0.74), respectively. In the test-negative design, 8.4% of 75,726 test-positive cases and 13.1% of 340,898 test-negative controls had received ≥1 RZV dose. The aOR (95% CI) was 0.84 (0.81-0.86). Conclusion RZV vaccination was associated with a 16% lower risk of COVID-19 diagnosis and 32% lower risk of hospitalization. Further study of vaccine-induced non-specific immunity for potential attenuation of future pandemics is warranted.

Vaccinations and Healthy Ageing: How to Rise to the Challenge Following a Life-Course Vaccination Approach

“…For HZV, the recent introduction of adjuvanted recombinant herpes zoster vaccine has dramatically improved vaccine efficacy compared to live attenuated zoster vaccines. Indeed, whereas live attenuated varicella zoster vaccine presented age-dependent vaccine efficacy, dropping from 64% in the 60-69 age group to 41% in the 70-79 age group, herpes zoster adjuvanted recombinant vaccine has demonstrated elevated and age-independent vaccine efficacy [22,36,37], corroborated by the previous reported evidence of the possible protection against severe COVID-19 symptoms [34].…”

“…For instance, a meta-analysis showed that all-cause mortality in children was reduced by 49% after administration of measles vaccination [ 17 , 32 ], and studies have found a correlation between BCG vaccination and reduced COVID-19 mortality [ 17 , 33 ]. In addition, the EPI-ZOSTER-089 study assessed whether recombinant herpes zoster vaccination (RZV) resulted in a lower risk of COVID-19 [ 34 ]. The study involved two approaches, namely, a matched cohort and a test negative approach, in order to reduce the risk of bias; the two approaches provided consistent results.…”

“…In particular, vaccination with at least one dose of RZV was associated with a 16% lower rate of diagnosis of COVID-19 and a 32% lower rate of hospitalisation. Vaccination with two doses of RZV was associated with a 19% lower rate of COVID-19 diagnosis and a 36% lower rate of hospitalisation (after adjusting for BMI, smoking habit, number of outpatient visits, hypertension, and other vaccination-related covariates) [ 34 ].…”

Durability of BNT162b2 vaccine against hospital and emergency department admissions due to the omicron and delta variants in a large health system in the USA: a test-negative case–control study

“…Unrelated live attenuated vaccines and adjuvanted vaccines can provide sustained protection against heterologous infections and severe outcomes, including COVID-19, possibly through induction of trained innate immunity, which mRNA vaccines also induce. 31 , 32 , 33 …”

Correspondence to Recombinant Adjuvanted Zoster Vaccine and Reduced Risk of Coronavirus Disease 2019 Diagnosis and Hospitalization in Older Adults

“…To the Editor —We read with great interest the article by Bruxvoort et al reporting that recombinant adjuvanted zoster vaccine vaccination was associated with a lower risk of coronavirus disease 2019 (COVID-19) diagnosis and COVID-19 hospitalization [ 1 ]. We wish to highlight some key points.…”