Best of 2024: Inadequate Zoster Vaccination in Immunocompromised Patients Save

Editor's note: this article originally appeared October 15, 2024 and is being shared again as a Best of 2024. Enjoy!

A VA study of shows that recombinant zoster vaccine (RZV) vaccination in immunocompromised patients or those receiving immunosuppressive medications is insufficient, given these are high risk individuals.

The recombinant zoster vaccine (RZV; or "Shingrix") was FDA approved In 2017 for use in adults over age 50 years, with an expanded indication in 2021, to include adults over 18 years who are immunocompromised. Yet there is little published data regarding RZV vaccination efficacy and safety in immunocompromised patients, especially those younger than 50 years. 

The current study from the US Veterans Health Administration, uses VA  health care system data and included 190,162 veterans receiving immunosuppressive medications, 12.3% (23 295) of whom were under age 50 years. The primary outcome was the percentage of veterans with 1 or more RZV doses documented during the study period (2018 to 2023). 

In veterans aged 50 years or older, 36% had an RZV vaccination before the expanded indication and 50% had it by mid-2023.

For those veterans under age 50 years, less than 3% received RZV before the expanded indication and 13% by mid-2023. 

Those unlikely to receive RZV vaccination included male sex, African American and unknown race, and nonurban residence; but RZV vaccination was increased in those treated with tsDMARDs, bDMARDs or a combination of csDMARDs/bDMARDs and glucocorticoids. 

The percentage of veterans with 1 or more RZV doses at any time ranged from 18% to 71%. Overall, less than half of veterans in the US taking chronic immunosuppressive medications received even 1 dose of RZV; for patients younger than 50 years, percentages were much lower.

Future efforts to improve RZV vaccination in high risk patients should use informatics tools to identify those at high risk, regardless of clinical setting or subspecialty.