Risk factors for herpes zoster: should people with asthma or COPD be vaccinated?

Abstract

Without vaccination, an estimated 1 in 3 individuals will develop herpes zoster (HZ) in their lifetime. Increased risk of HZ is attributed to impaired cell-mediated immunity, as observed in age-related immunosenescence or in individuals immunocompromised due to disease or immunosuppressive treatments. Most vaccination guidelines recommend HZ vaccination in all adults ≥ 50 years of age, although Shingrix® was recently approved by the U.S. Food and Drug Administration for use in individuals aged ≥ 18 years who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression caused by known disease or therapy, followed by approval by the European Medicines Agency for use in immunocompromised individuals aged ≥ 18 years. Chronic respiratory diseases are also risk factors for HZ. A new meta-analysis reported 24% and 41% increased risks of HZ in those with asthma and chronic obstructive pulmonary disorder (COPD), respectively, compared with healthy controls. Asthma and COPD increase a person’s risk of HZ and associated complications at any age and may be further elevated in those receiving inhaled corticosteroids. Despite the increased risks, there is evidence that HZ vaccination uptake in those aged ≥ 50 years with COPD may be lower compared with the age-matched general population, potentially indicating a lack of awareness of HZ risk factors among clinicians and patients. The 2022 Global Initiative for Chronic Lung Disease report recognizes that Centers for Disease Control and Prevention recommended to vaccinate those aged ≥ 50 years against HZ, although health systems should consider the inclusion of all adults with asthma or COPD into their HZ vaccination programs. Further research into HZ vaccine efficacy/effectiveness and safety in younger populations is needed to inform vaccination guidelines. Graphical Abstract

Safety of Biological Therapies for Severe Asthma: An Analysis of Suspected Adverse Reactions Reported in the WHO Pharmacovigilance Database

“…Some studies have investigated the potential link between asthma and the development of herpes zoster infection caused by the re-activation of latent varicella zoster virus [ 78 – 80 ]. Many risk factors could play a role in this re-activation, such as stress, immunosuppression condition, age or some debilitating diseases that compromise the immune system, like asthma [ 79 ].…”

“…Many risk factors could play a role in this re-activation, such as stress, immunosuppression condition, age or some debilitating diseases that compromise the immune system, like asthma [ 79 ]. For this reason, the herpes zoster immunization is primarily suggested for asthmatic adults aged 50 years or more [ 78 , 80 ]. Nevertheless, a recent review focusing on the risks of asthma biologic therapy underlined that a small percentage of patients receiving dupilumab, mepolizumab and benralizumab developed a herpes zoster infection and this risk is already labelled for mepolizumab [ 81 ].…”

COVID-19 and herpes zoster: a call to action

“…HZ usually presents as acute, painful vesicular rashes that can be debilitating and lead to physical disability and emotional distress. The most common complications of HZ are post-herpetic neuralgia (PHN) (occurring in 5–30% of cases), which could impact the quality of life for months or even years, and HZ ophthalmicus (HZO) (occurring in up to 10% of cases), which can lead to blindness ( 1 ). Moreover, HZ patients have an increased likelihood of developing a stroke within 30 days following infection, a risk that is mitigated with at least one zoster vaccination ( 2 ).…”

“…The risk of HZ increases as immune function declines, which is linked to aging and/or immunocompromising or immunosuppressive diseases or therapies ( 4 ). Other risk factors include asthma, chronic heart disease (CHD), chronic obstructive pulmonary disorder (COPD), depression, and rheumatoid arthritis (RA) ( 1 ). Currently, two major types of vaccines are available for HZ, namely Zostavax, which contains live attenuated varicella-zoster virus (ZVL), and Shingrix, a recombinant zoster vaccine (RZV) containing recombinant glycoprotein E in combination with a novel adjuvant ( 5 ).…”

Public Perception in Saudi Arabia Toward Herpes Zoster and Its Vaccination: A Cross-Sectional Study

“…HZ typically affects elderly and immunocompromised people, causing major distress due to complications such as postherpetic neuralgia (PHN) [ 4 ]. PHN is one of the major debilitating conditions affecting about 5-30% of HZ patients, resulting in chronic pain and a serious influence on the patient's quality of life [ 5 ].…”