AB1072 HERPES ZOSTER IN INDIVIDUALS WITH AUTOIMMUNE DISEASES AND RECOMBINANT HERPES ZOSTER VACCINE AS A PREVENTATIVE STRATEGY

Abstract

BackgroundIndividuals with autoimmune diseases (AIDs) are particularly vulnerable to herpes zoster (HZ) and its related complications. Although the live attenuated HZ vaccine is contraindicated in many of these individuals, the two-dose non-live recombinant zoster vaccine (RZV) can be used in immunosuppressed individuals. Based on accumulating data from RZV studies within specific immunosuppressive conditions, recently updated guidelines recommend RZV not only in immunocompetent adults aged ≥50 years, but also in adults aged ≥18 years (EU)/≥19 years (USA) at risk of HZ due to immunodeficiency or immunosuppression.1–3ObjectivesTo evaluate the burden of HZ in individuals with AIDs and the use of RZV as a preventative strategy.MethodsWe reviewed PubMed for available data on HZ incidence, summarised RZV data (effectiveness and safety) and the current recommendations for RZV in individuals with AIDs. The latest search was conducted in September 2021.ResultsHZ incidence in the general population is 4–7/1000 person-years (increases with age) and 8–15/1000 person-years in individuals with AIDs. Common immunosuppressive and immunomodulatory therapies can predispose individuals to HZ, as shown by large meta-analyses of interventional and observational studies. No published randomised controlled trial data of RZV in AID populations were found in our search. In two retrospective cohort studies in patients with inflammatory bowel disease (IBD), 4,5 RZV demonstrated high vaccine effectiveness (OR 0.64; 95% CI 0.44, 0.77).4 In a real-world observational study investigating RZV in beneficiaries of the Medicare national health insurance program in the USA, individuals with AIDs achieved vaccine effectiveness of 68.0% (95% CI 62.3%, 72.8%), which was similar to the overall population (70.1% [95% CI 68.6%, 71.5%]).6 In two single-centre, retrospective studies of RZV in individuals with AIDs, including rheumatoid arthritis (RA), adverse events after the first RZV dose were mild7,8. Disease flares were uncommon, mild and self-limiting, although a flare at the first RZV dose was significantly associated with an increased risk of a flare at the second dose (hazard ratio 3.9; P=0.0015)7. In addition, glucocorticoid use during vaccination was significantly associated with flares (odds ratio [OR] 2.31; P=0.004; Lenfant, 2021)7. In a study of individuals with IBD, receiving ≥1 RZV dose was associated with a low flare rate9. Current RZV guidelines vary by country and will be revised as new data emerge. Ongoing studies include phase 4 studies of individuals with RA and IBD receiving immunotherapies, and a study investigating the immunogenicity and safety of RZV in individuals with stable systemic lupus erythematosus.ConclusionIndividuals with AIDs are at increased risk of HZ and its related complications, which may be due to either or both of their underlying condition and the treatment(s) they are receiving. The developing collective scientific evidence from the published literature on RZV in individuals with AIDs demonstrates a favourable benefit:risk profile for RZV in this population which contributed to the recent USA ACIP recommendation. Further studies are warranted to evaluate potential effects of individual conditions and immunotherapies on vaccine efficacy and methods to optimise vaccine use.