Use of Recombinant Zoster Vaccine in Immunocompromised Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022

Anderson, Tara; Masters, Nina B.; Guo, Angela; Shepersky, Leah; Leidner, Andrew J.; Lee, Grace M.; Kotton, Camille Nelson; Dooling, Kathleen

doi:10.15585/mmwr.mm7103a2

Cited by 113 publications

(68 citation statements)

References 18 publications

(43 reference statements)

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“…This study indicates the updated ACIP recommendations for RZV use in immunocompromised adults aged ≥ 19 years 23 will be welcomed by many primary care physicians and are congruent with what many are already doing. However, knowledge gaps, communication issues, and financial barriers need to be addressed to optimize vaccination delivery and improve national RZV vaccination rates.…”

Section: Discussionmentioning

confidence: 56%

Survey of Physician Practices, Attitudes, and Knowledge Regarding Recombinant Zoster Vaccine

et al. 2022

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Background Herpes zoster vaccination rates remain low despite longstanding national recommendations to vaccinate immunocompetent adults aged ≥ 50 years. The Advisory Committee on Immunization Practice (ACIP) updated its recommendations for recombinant zoster vaccine (RZV) in October 2021 to include immunocompromised adults aged ≥19 years. Objective To assess practices, attitudes, and knowledge about RZV, barriers to recommending RZV, and likelihood of recommending RZV to patients with various immunocompromising conditions. Design Mail and internet-based survey conducted from May through July 2020. Participants General internists and family physicians throughout the USA. Main Measures Survey responses. Key Results The response rate was 66% (632/955). Many physicians were already recommending RZV to immunocompromised populations, including adults ≥50 years with HIV (67% of respondents) and on recombinant human immune modulator therapy (56%). Forty-seven percent of respondents both stocked/administered RZV and referred patients elsewhere, frequently a pharmacy, for vaccination; 42% did not stock RZV and only referred patients. The majority agreed pharmacies do not inform them when RZV has been given (64%). Physicians were generally knowledgeable about RZV; however, 25% incorrectly thought experiencing side effects from the first dose of RZV that interfere with normal activities was a reason to not receive the second dose. The top reported barrier to recommending RZV was experience with patients declining RZV due to cost concerns (67%). Most physicians reported they would be likely to recommend RZV to immunocompromised patients. Conclusion Most primary care physicians welcome updated ACIP RZV recommendations for immunocompromised adults. Knowledge gaps, communication issues, and financial barriers need to be addressed to optimize vaccination delivery. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-022-07721-z.

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Section: Discussionmentioning

confidence: 56%

Survey of Physician Practices, Attitudes, and Knowledge Regarding Recombinant Zoster Vaccine

et al. 2022

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“…The inactivated RZV has demonstrated a clinical efficacy of 68.2% to prevent HZ after autologous HSCT and has been recently shown in a prospective cohort study to be safe after allo-HSCT, although immunogenicity data in this setting are lacking ( 39 , 40 ). The RZV has been recently recommended to immunocompromised adults, including allo-HSCT recipients, in the USA, but is not currently available in France ( 41 ).…”

Section: Discussionmentioning

confidence: 99%

“…HI (n = 17) and allo-HSCT recipients (n = 60) were included. HI and allo-HSCT recipients did not significantly differ in terms of age (median [IQR], 42 [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] vs. 44.5 years, P = .39) and sex (sex ratio, 1.1 vs. 1.3, P = .79). Allo-HSCT recipients were enrolled at a median [IQR] time of 6 [5][6][7][8] months posttransplant.…”

Section: Participant Characteristicsmentioning

confidence: 99%

A Simple-to-Perform ifn-γ mRNA Gene Expression Assay on Whole Blood Accurately Appraises Varicella Zoster Virus-Specific Cell-Mediated Immunity After Allogeneic Hematopoietic Stem Cell Transplantation

et al. 2022

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Herpes zoster, which is due to the reactivation of Varicella zoster virus (VZV), is a leading cause of morbidity after allogeneic hematopoietic stem cell transplantation (allo-HSCT). While cell-mediated immunity (CMI) is critical to inhibiting VZV reactivation, CMI is not routinely assessed due to a lack of reliable tests. In this study, we aimed to evaluate VZV-specific CMI among allo-HSCT recipients (n = 60) and healthy individuals (HI, n = 17) through a panel of three immune functional assays after ex vivo stimulation by VZV antigen: quantification of (i) IFN-γ release in the supernatants, (ii) T-cell proliferation after a 7-day stimulation of peripheral blood mononuclear cells (PBMC), and (iii) measurement of the ifn-γ mRNA gene expression level after 24 h of stimulation of a whole-blood sample. VZV responsiveness was defined according to IFN-γ release from VZV-stimulated PBMC. Upon VZV stimulation, we found that allo-HSCT recipients at a median time of 6 [5-8] months post-transplant had lower IFN-γ release (median [IQR], 0.34 [0.12–8.56] vs. 409.5 [143.9–910.2] pg/ml, P <.0001) and fewer proliferating T cells (0.05 [0.01–0.57] % vs. 8.74 [3.12–15.05] %, P <.0001) than HI. A subset of allo-HSCT recipients (VZV-responders, n = 15/57, 26%) distinguished themselves from VZV-non-responders (n = 42/57, 74%; missing data, n = 3) by higher IFN-γ release (80.45 [54.3–312.8] vs. 0.22 [0.12–0.42] pg/ml, P <.0001) and T-cell proliferation (2.22 [1.18–7.56] % vs. 0.002 [0.001–0.11] %, P <.0001), suggesting recovery of VZV-specific CMI. Interestingly, VZV responders had a significant fold increase in ifn-γ gene expression, whereas ifn-γ mRNA was not detected in whole blood of VZV-non-responders (P <.0001). This study is the first to suggest that measurement of ifn-γ gene expression in 24-h-stimulated whole blood could be an accurate test of VZV-specific CMI. The routine use of this immune functional assay to guide antiviral prophylaxis at an individual level remains to be evaluated.

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“…Vaccine-specific changes in the 2022 immunization schedule for adults aged ≥19 years include new or updated ACIP recommendations for hepatitis B vaccine (HepB) ( 2 ), influenza vaccine ( 3 ), pneumococcal vaccines ( 4 ), recombinant zoster vaccine (RZV) ( 5 ), and COVID-19 vaccine (available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html ). Changes have also been made to the human papillomavirus (HPV); measles, mumps, and rubella (MMR); meningococcal; and varicella (VAR) vaccination sections to improve clarity in the language.…”

Section: Changes In the 2022 Adult Immunization Schedulementioning

confidence: 99%

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2022

Murthy¹,

Wodi²,

Bernstein³

et al. 2022

MMWR Morb. Mortal. Wkly. Rep.

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Use of Recombinant Zoster Vaccine in Immunocompromised Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022

Cited by 113 publications

References 18 publications

Survey of Physician Practices, Attitudes, and Knowledge Regarding Recombinant Zoster Vaccine

Survey of Physician Practices, Attitudes, and Knowledge Regarding Recombinant Zoster Vaccine

A Simple-to-Perform ifn-γ mRNA Gene Expression Assay on Whole Blood Accurately Appraises Varicella Zoster Virus-Specific Cell-Mediated Immunity After Allogeneic Hematopoietic Stem Cell Transplantation

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2022

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