The Adjuvanted Recombinant Zoster Vaccine in Adults Aged ≥65 Years Previously Vaccinated With a Live-Attenuated Herpes Zoster Vaccine

Dagnew, Alemnew F.; Klein, Nicola P.; Hervé, Caroline; Kalema, George; Paolo, Emmanuel Di; Peterson, James T.; Salaun, Bruno; Schuind, Anne

doi:10.1093/infdis/jiaa083

Cited by 16 publications

(16 citation statements)

References 30 publications

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“…The NCT02581410 trial investigated the effect of recombinant HZV (Shingrix, GSK) in elderly patients who either had been vaccinated with live attenuated HZV vaccine ≥5 years before or were HZV naive. Recombinant HZV induced a strong humoral and cell-mediated immune response that persisted above prevaccination levels for 12 months following the second dose, irrespective of previous vaccination [100].…”

Section: Vaccinationmentioning

confidence: 94%

Herpes zoster: A Review of Clinical Manifestations and Management

Patil

Goldust

Wollina

2022

Viruses

183

123

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The Varicella-zoster virus (VZV) or human herpes virus 3 is a neurotropic human alpha herpes virus responsible for chickenpox/varicella and shingles/herpes zoster (HZ). This review will focus on HZ. Since HZ is secondary to varicella, its incidence increases with age. In children and youngsters, HZ is rare and associated to metabolic and neoplastic disorders. In adults, advanced age, distress, other infections (such as AIDS or COVID-19), and immunosuppression are the most common risk factors. HZ reactivation has recently been observed after COVID-19 vaccination. The disease shows different clinical stages of variable clinical manifestations. Some of the manifestations bear a higher risk of complications. Among the possible complications, postherpetic neuralgia, a chronic pain disease, is one of the most frequent. HZ vasculitis is associated with morbidity and mortality. Renal and gastrointestinal complications have been reported. The cornerstone of treatment is early intervention with acyclovir or brivudine. Second-line treatments are available. Pain management is essential. For (secondary) prophylaxis, currently two HZV vaccines are available for healthy older adults, a live attenuated VZV vaccine and a recombinant adjuvanted VZV glycoprotein E subunit vaccine. The latter allows vaccination also in severely immunosuppressed patients. This review focuses on manifestations of HZ and its management. Although several articles have been published on HZ, the literature continues to evolve, especially in regard to patients with comorbidities and immunocompromised patients. VZV reactivation has also emerged as an important point of discussion during the COVID-19 pandemic, especially after vaccination. The objective of this review is to discuss current updates related to clinical presentations, complications, and management of HZ.

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Section: Vaccinationmentioning

confidence: 94%

Herpes zoster: A Review of Clinical Manifestations and Management

Patil

Goldust

Wollina

2022

Viruses

183

123

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“… 20 These findings were later confirmed in the control arm of a trial evaluating immunogenicity of RZV in previous live-attenuated zoster vaccine (ZVL, Zostavax, Merck Sharp & Dohme Corp.) recipients. 27 In a similar evaluation, polyfunctionality was assessed in this study selecting the following four T-cell markers: IL-2, CD40L, which are the dominant activation markers shortly post-vaccination, 20 and IFN-γ and TNF-α, which correlate best with vaccine-induced protection. 28 , 29 The proportion of polyfunctional CD4 T cells increased from 1 M to 24 M post-second vaccine dose, an increase observed previously in adults aged ≥50 years.…”

Section: Discussionmentioning

confidence: 99%

Adjuvanted recombinant zoster vaccine in adult autologous stem cell transplant recipients: polyfunctional immune responses and lessons for clinical practice

Stadtmauer

Sullivan

Idrissi

et al. 2021

Human Vaccines & Immunotherapeutics

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Immunocompromised individuals, particularly autologous hematopoietic stem cell transplant (auHSCT) recipients, are at high risk for herpes zoster (HZ). We provide an in-depth description of humoral and cell-mediated immune (CMI) responses by age (protocol-defined) or underlying disease (post-hoc) as well as efficacy by underlying disease (post-hoc) of the adjuvanted recombinant zoster vaccine (RZV) in a randomized observer-blind phase III trial (ZOE-HSCT, NCT01610414). 1846 adult auHSCT recipients were randomized to receive a first dose of either RZV or placebo 50–70 days post-auHSCT, followed by the second dose at 1–2 months (M) later. In cohorts of 114–1721 participants, at 1 M post-second vaccine dose: Anti-gE antibody geometric mean concentrations (GMCs) and median gE-specific CD4[2+] T-cell frequencies (CD4 T cells expressing ≥2 of four assessed activation markers) were similar between 18–49 and ≥50-year-olds. Despite lower anti-gE antibody GMCs in non-Hodgkin B-cell lymphoma (NHBCL) patients, CD4[2+] T-cell frequencies were similar between NHBCL and other underlying diseases. The proportion of polyfunctional CD4 T cells increased over time, accounting for 79.6% of gE-specific CD4 T cells at 24 M post-dose two. Vaccine efficacy against HZ ranged between 42.5% and 82.5% across underlying diseases and was statistically significant in NHBCL and multiple myeloma patients. In conclusion, two RZV doses administered early post-auHSCT induced robust, persistent, and polyfunctional gE-specific immune responses. Efficacy against HZ was also high in NHBCL patients despite the lower humoral response.

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“…Regarding RZV administration in patients previously vaccinated for HZ, a phase-III, multi-center trial on RZV vaccine immunogenicity in previous ZVL vaccines compared to non-ZVL vaccinated patients demonstrated sustained humoral and cell-mediated immune responses regardless of prior vaccination status; 25 moreover, no difference in adverse events was observed, suggesting that RZV can be safely used in patients previously vaccinated with ZVL. 25 The recommended interval between vaccination with the two HZ vaccines varies from country to country, with some without recommended minimum interval (e.g. Italy), while others recommend at least 5-year interval in between the two vaccines (e.g.…”

Section: Current Landscape Of Hz Vaccinesmentioning

confidence: 99%

“…24 Regarding RZV administration in patients previously vaccinated for HZ, a phase-III, multi-center trial on RZV vaccine immunogenicity in previous ZVL vaccines compared to non-ZVL vaccinated Lyophilized (reconstituted with AS01 B adjuvant) 13 Approval date by FDA 5/2006 (for >60 years old), 3/2011 (for 50-59 years old) 13 10/2017 (for >50 years old) 13 Vaccine schedule (U.S.) Previously in >60 years old via a single dose. No longer used in the United States as of 11/2020 14 Adults >50 years old in two-dose series (2-6 months apart); immediate use as booster in patients previously vaccinated with ZVL 15 Duration of protection 8 years (for reducing HZ incidence); 10 years (for reducing HZ burden of disease, e.g., pain and discomfort) 16 7 years (for reducing HZ incidence; 14 patients demonstrated sustained humoral and cell-mediated immune responses regardless of prior vaccination status; 25 moreover, no difference in adverse events was observed, suggesting that RZV can be safely used in patients previously vaccinated with ZVL. 25 The recommended interval between vaccination with the two HZ vaccines varies from country to country, with some without recommended minimum interval (e.g.…”

Section: Vaccine Administration and Special Considerationsmentioning

confidence: 99%

Global herpes zoster incidence, burden of disease, and vaccine availability: a narrative review

Pan

Lee

Nambudiri

2022

Therapeutic Advances in Vaccines and Immunotherapy

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Herpes zoster (HZ) is a neurocutaneous disease that causes significant morbidity worldwide. The disease is caused by the reactivation of the varicella-zoster virus (VZV), which leads to the development of a painful, vesicular rash and can cause complications such as post-herpetic neuralgia and vision loss. Globally, the incidence of HZ is increasing, and it incurs billions in cost annually to the healthcare system and to society through loss of productivity. With the advent of effective vaccines such as the live attenuated vaccine, Zostavax®, in 2006, and more recently the adjuvant recombinant subunit vaccine, Shingrix®, in 2017, HZ has become a preventable disease. However, access to the vaccines remains mostly limited to countries with developed economies, such as the United States and Canada. Even among countries with developed economies that license the vaccine, few have implemented HZ vaccination into their national immunization schedules due to cost-effectiveness considerations. In this review, we discuss the currently available HZ vaccines, landscape of HZ vaccine guidelines, and economic burden of disease in countries with developed and developing economies, as well as barriers and considerations in HZ vaccine access on a global scale.

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The Adjuvanted Recombinant Zoster Vaccine in Adults Aged ≥65 Years Previously Vaccinated With a Live-Attenuated Herpes Zoster Vaccine

Cited by 16 publications

References 30 publications

Herpes zoster: A Review of Clinical Manifestations and Management

Herpes zoster: A Review of Clinical Manifestations and Management

Adjuvanted recombinant zoster vaccine in adult autologous stem cell transplant recipients: polyfunctional immune responses and lessons for clinical practice

Global herpes zoster incidence, burden of disease, and vaccine availability: a narrative review

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