A comprehensive review of studies conducted across various patient groups suggests that the benefits of vaccination with recombinant zoster vaccine outweigh safety concerns, particularly in immunocompromised populations.
Co-authored by Dr. Francis A. Farraye, a gastroenterologist and professor of medicine at Mayo Clinic in Florida, the review emphasizes the significance of herpes zoster prophylaxis in immunocompromised patients. Dr. Farraye underscores the importance of vaccination, especially with the recent Advisory Committee on Immunization Practices (ACIP) recommendation advocating for immunocompromised patients or those likely to become immunocompromised in the future, as they face an elevated risk of developing herpes zoster.
The study, published in Vaccine (2023;41[1]:36-48), aimed to bridge the gap in understanding the vaccine’s efficacy and safety profile across different patient populations. The findings suggest that the recombinant RZV (Shingrix, GSK) is both safe and effective across the immunocompromised populations studied.
Dr. Joanna Schaenman, an expert in transplant infectious diseases and a professor of medicine at the University of California, Los Angeles, commends the review for providing a consolidated source of zoster risk and vaccination data for vulnerable patient populations. She highlights the fragmented care prevalent among patients at risk for shingles and emphasizes the need for a multispecialty approach to prevent morbidity and potential mortality associated with the disease.
To address missed opportunities for vaccination, Dr. Schaenman recommends increased awareness and collaboration among specialists caring for immunocompromised patients. She suggests that societies of involved specialists should advocate for vaccination recommendations, especially prior to the initiation of immunosuppressive therapy when feasible.
Dr. Farraye echoes the need for non-infectious disease specialists to prioritize vaccination recommendations, emphasizing the role of gastroenterologists as primary caregivers for immunocompromised patients.
One proposed strategy to enhance vaccination uptake involves leveraging electronic health records to prompt clinicians to consider the RZV based on patient-specific factors. The authors stress the importance of generating more data for specific patient subgroups, particularly regarding the timing of vaccine administration and the impact of immunosuppressive therapy on vaccine efficacy.
While ideally, vaccination should precede immunosuppression to maximize efficacy, Dr. Schaenman emphasizes the feasibility and benefits of vaccinating stable immunocompromised patients. She points to recent studies in transplant patients to support this assertion.
From a health economics perspective, Dr. Farraye’s research suggests that Shingrix vaccination is not only cost-effective but also cost-saving in populations with inflammatory bowel disease (IBD).
Overall, the study underscores the importance of vaccination in immunocompromised populations and advocates for increased awareness and collaboration among healthcare providers to optimize vaccination uptake and improve outcomes for these vulnerable patients.
