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Immunocompromised patients face increased herpes zoster risk. While a live zoster vaccine is safe for most, its use in immunocompromised individuals, including those on biologic drugs, requires further study.

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Area of Science:

  • Immunology
  • Virology
  • Vaccinology

Background:

  • Herpes zoster poses significant risks, especially for immunocompromised individuals.
  • Immunomodulating drugs and conditions like advanced age or glucocorticoid therapy elevate zoster risk.
  • The safety and efficacy of certain immunosuppressants (e.g., methotrexate, TNFα antagonists, rituximab) in relation to zoster are under ongoing investigation.

Purpose of the Study:

  • To review the current understanding of herpes zoster risk in patients with compromised immune systems.
  • To evaluate the existing data on the live attenuated herpes zoster vaccine in immunocompetent versus immunocompromised populations.
  • To highlight the need for defining vaccination guidelines for specific patient groups and therapeutic exposures.

Main Methods:

  • Literature review of studies on herpes zoster incidence in patients receiving immunomodulating therapies.
  • Analysis of available data on the safety and efficacy of the live attenuated herpes zoster vaccine.
  • Examination of risk factors associated with herpes zoster in various patient populations.

Main Results:

  • Patients on biological agents or with other immunodeficiencies have an increased risk of herpes zoster.
  • The live attenuated herpes zoster vaccine is effective and safe in immunocompetent individuals.
  • Current data suggest potential effectiveness and safety of the zoster vaccine in immunocompromised patients, but further studies are needed.

Conclusions:

  • Further research is essential to establish the risk-benefit profile of the herpes zoster vaccine in immunocompromised patients.
  • Clearer indications for herpes zoster vaccination are needed, considering patient disease, age, VZV status, and therapeutic agents.
  • Alternative strategies to prevent herpes zoster in vulnerable populations are under development.