Efficacy of Recombinant Zoster Vaccine in Adults ≥50 with Autoimmune Diseases
Overview
This real-world retrospective cohort study demonstrated that two doses of the adjuvanted recombinant zoster vaccine (RZV) significantly reduce herpes zoster (HZ) incidence in adults aged 50 and older with autoimmune diseases (AIDs). Vaccine effectiveness (VE) ranged from 48.1% in multiple sclerosis to 77.2% in psoriasis, with an overall VE of 66.3%.
Background
Herpes zoster results from reactivation of varicella-zoster virus and is more common in individuals with autoimmune diseases (AIDs) such as rheumatoid arthritis, systemic lupus erythematosus, and multiple sclerosis. These patients are at increased risk due to underlying immunosuppression and immunosuppressive therapies. The adjuvanted recombinant zoster vaccine (RZV) was approved for adults aged 50 and older to prevent HZ, but data on its effectiveness in AID populations have been limited. This study addresses this gap by evaluating RZV effectiveness in a large US claims database.
Data Highlights
Autoimmune Disease
Vaccine Effectiveness (%)
Multiple Sclerosis (MS)
48.1
Psoriasis (PsO)
77.2
Overall (All AIDs)
66.3 (95% CI: 61.4–70.7)
HZ incidence decreased from 12.9 to 4.3 per 1000 person-years in vaccinated versus unvaccinated patients.
Key Findings
Two doses of RZV reduced HZ incidence from 12.9 to 4.3 per 1000 person-years in adults ≥50 with AIDs.
Overall vaccine effectiveness against HZ was 66.3% (95% CI: 61.4–70.7).
VE varied by autoimmune condition, with highest effectiveness in psoriasis (77.2%) and lowest in multiple sclerosis (48.1%).
Matching and propensity score adjustment accounted for confounders including age, medication use, and comorbidities.
Findings are consistent with prior clinical trial data and support RZV use in immunocompromised populations.
Clinical Implications
Clinicians should consider recommending the two-dose RZV series to adults aged 50 and older with autoimmune diseases to reduce the risk of herpes zoster. The vaccine demonstrates substantial effectiveness despite immunosuppressive therapies. Monitoring vaccination timing and adherence to the two-dose schedule is important to maximize protection.
Conclusion
This study provides robust real-world evidence that RZV vaccination effectively prevents herpes zoster in adults aged 50 and older with selected autoimmune diseases, supporting current vaccination guidelines in this high-risk population.
References
Optum Clinformatics Data Mart Database Study 2018-2021 -- Efficacy of the Adjuvanted Recombinant Zoster Vaccine in Adults Aged 50 and Older with Autoimmune Disorders
