Herpes zoster vaccination among immunocompromised adults in the United States

In October 2021, the Advisory Committee on Immunization Practices (ACIP) recommended two doses of recombinant zoster vaccine (RZV) 1-6 months apart for immunocompromised adults aged ≥19 years, though usage data remain limited.

This retrospective cohort analysis used IQVIA claims data to evaluate RZV uptake (one or more doses) and completion (two doses) among RZV-naïve immunocompromised patients aged ≥19 years. Immunocompromised status was based on autoimmune/immunocompromising conditions and/or antineoplastic/immunocompromising medication use, during the 6 months before the ACIP voting date. Uptake was assessed through June 2023. Six- and 12-month completion was assessed in patients with a first dose before January 2023. Time to completion was estimated by Kaplan-Meier analysis. Generalized estimation equation models assessed factors associated with uptake and completion within 1-6 months.

Among 2,595,572 RZV-naïve patients (75.7 % aged ≥50 years), uptake was 8.2 % (2.0 % for age 19-49 years; 10.1 % for ≥50 years) by June 2023. Among RZV initiators, 62.1 % and 70.0 % received a second dose within 6 and 12 months, respectively. Median time to second dose was 4.2 months. Among patients with two doses (any time), 88.5 % received the second dose within 1-6 months. After adjustment, factors indicating higher odds of uptake included HIV, Hispanic ethnicity, non-Hispanic Asian/other race, and higher education/income, lower odds included younger age, greater social disadvantage, transplant, and cancer or antineoplastic/immunocompromising medication. Factors associated with increased odds of series completion included higher income and first-dose administration in a pharmacy, while factors with reduced odds included younger age, non-Hispanic African American or Hispanic race/ethnicity, Charlson Comorbidity Index score ≥ 2, and transplant.

RZV uptake among immunocompromised patients was low in the 20 months following the ACIP recommendation. However, once initiated, timely completion was likely. Targeted efforts are needed to improve HZ prevention, especially in younger immunocompromised populations.