Two doses of recombinant zoster vaccine provide strong protection against shingles
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Key takeaways:
- The effectiveness of full vaccination was 73% after 3 to 4 years.
- In contrast, the effectiveness of partial vaccination was 52% after 4 years.
Two doses of the recombinant zoster vaccine provided strong protection over 4 years, even in patients taking corticosteroids who are at higher risk for herpes zoster, also known as shingles, according to researchers.
Currently, the CDC recommends that adults aged 50 years and older receive two doses of the recombinant zoster vaccine (RZV) separated by a period of 2 to 6 months.
Ousseny Zerbo, PhD, a research scientist in the Vaccine Study Center at Kaiser Permanente Northern California Division of Research, and colleagues explained that clinical trials of RZV demonstrated effectiveness that “did not wane substantially during at least 7 years of follow-up.”
“However, the long-term effectiveness of RZV has not been extensively studied in real-world settings,” they wrote in Annals of Internal Medicine.
The researchers aimed to expand literature through a prospective cohort study where participants received either one, two or no doses of RZV from Jan. 1, 2018, through Dec. 31, 2022.
The cohort consisted of 1,996,885 participants aged 50 years and older who contributed 7.6 million person-years of follow-up. During the study period, 38% received at least one dose and 29% received two doses.
The researchers found that, after adjustment for covariates, the overall vaccine effectiveness was 64% for one dose of RZV and 76% for two doses.
After one RZV dose, vaccine effectiveness was:
- 70% during the first year;
- 45% during the second year;
- 48% during the third year; and
- 52% during the fourth year.
In contrast, among those fully vaccinated, RZV vaccine effectiveness was:
- 79% during the first year;
- 75% during the second year; and
- 73% during the third and fourth years.
Zerbo and colleagues noted that vaccine effectiveness was slightly stronger in those fully vaccinated before age 65 years and lower in those who were immunocompromised due to corticosteroid use when they were vaccinated. Overall, vaccine effectiveness was 65% in persons who received corticosteroids before vaccination vs. 77% in those who did not.
However, the overall effectiveness of two RZV doses in the study was lower than that found in previous clinical trials, where RZV was 97% effective in those aged 50 years and older and 90% effective in those aged 70 years and older.
“One reason our [vaccine effectiveness] estimate was lower than the estimates in the trials may be that our case ascertainment was less specific than in the trials, where cases were confirmed by polymerase chain reaction testing,” the researchers wrote.
There were multiple limitations in the study, according to Zerbo and colleagues. For example, the population was limited to those with health insurance and thus not representative of other groups.
“Our finding that the effectiveness of [one] dose decreased after a year further supports the current recommendation for a second dose,” Zerbo and colleagues concluded.
References:
- Shingrix recommendations. https://www.cdc.gov/vaccines/vpd/shingles/hcp/shingrix/recommendations.html. Accessed Jan. 3, 2023.
- Zerbo O, et al. Ann Intern Med. 2023;doi:10.7326/M23-2023.
Perspective
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The real-world trial shows that the vaccine efficacy of the recombinant vaccine is over 70% in both immune-competent and compromised patients and is durable for 4 years.
The data overall substantiate the trial data and should be compelling enough to offer this vaccine in all patients older than 50 years of age and greater who are immunocompetent and immunocompromised because we know that over 30% of people aged older than 50 years get shingles and 13% to 20% will get post-herpetic neuralgia.
The efficacy of the recombinant vaccine in clinical trials to prevent shingles in ages 50 years and up is 97.2% in the first year. In those aged older than 70 years, it was 91.3% effective. The response was good regardless of age and immune status. Even after stem cell transplant or steroids, the response rate was 68% to 85%.
I take care of a large population of patients with HIV and offer it to my older population aged older than 50 years as well as my younger population if they are immunocompromised.
The vaccine is a recombinant vaccine, so it can be given to individuals who are immunocompetent as well as immunocompromised, unlike the live shingles vaccine, which is given to only immunocompetent patients.
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Zerbo O, et al. Ann Intern Med. 2023;doi:10.7326/M23-2023.
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