Studies with herpes zoster vaccines in immune compromised patients

ABSTRACT

Introduction: The active component of the herpes zoster vaccine (ZVL), licensed for people ≥50 years of age, is a live attenuated varicella-zoster virus. ZVL is contraindicated for immune compromised individuals, with limited regard to the degree of immunosuppression.

Areas covered: This review evaluates phase I and II and observational studies for ZVL, and published reports of the off-label use of ZVL, for conditions and therapies for which investigators considered the risk-benefit for using ZVL to be favorable. It also discusses exploratory trials of ZVL for additional immune compromising conditions, and summarizes clinical guidelines from many countries and professional societies that are based upon recent investigations. Studies in immune compromised patients of investigational vaccines that do not contain live virus are reviewed.

Expert commentary: It is likely that past and ongoing research with ZVL will define immune compromising diseases and/or therapies for which the risk-benefit for using ZVL vaccine is favorable. The main variables to consider in this assessment in immune compromised patients are safety, immunogenicity, protection against herpes zoster, and persistence of protection. Vaccination against herpes zoster prior to suppressing immunity is an important clinical strategy, although efficacy of this approach has not been evaluated in a clinical trial.

KEYWORDS:

• Herpes zoster
• herpes zoster vaccine
• immune compromised patient
• vaccines

Acknowledgments

The authors would like to thank Shefali Parikh for her assistance in conducting the literature search.

Declaration of interest

E Bresnitz, Z Popmihajlov, K-L Liaw and E Willis are all employees of Merck & Co., Inc. and may hold stock and/or stock options in the company. All authors have been investigators for Merck & Co., Inc and no author was paid for this manuscript. MJ Levin has received funds from Merck & Co for service in an advisory capacity and received funds for research and he shares a patent for the zoster vaccine. MJ Levin received funds from GlaxoSmithKline for service in an advisory capacity and received funds for research. A Weinberg received funds from Merck & Co and GlaxoSmithKline for research. JR Curtis received funds from the ACR Rheumatology Research Foundation and the NIH as well as consolation fees from Pfizer, Lilly, Amgen, Abbvie, UCB, BMS, Roche and Myriad genetics. The opinions expressed in the manuscript are those of the authorship and do not necessarily reflect those of Merck & Co., Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

The manuscript was not funded.