Zoster Vaccine Research Articles

Public health impact of herpes zoster vaccination on older adults in Hong Kong

ABSTRACT The growing burden of herpes zoster (HZ) in Hong Kong, due to an aging population with increasing life expectancy, may be reduced by vaccination. This study aimed to estimate public health impact of HZ vaccination in Hong Kong. The ZOster ecoNomic Analysis (ZONA) model was adapted with Hong Kong-specific key model inputs/assumptions, where available. Base case analysis involved adults ≥50 years of age (YOA), exploring three vaccination strategies (no vaccination/recombinant zoster vaccine [RZV]/zoster vaccine live [ZVL]) under private market (5% coverage) and mass vaccination (40% coverage) settings. Scenario and sensitivity analyses were performed. In the base case population (3.13 million), without vaccination, 891,024 HZ (28.4%), 156,097 post-herpetic neuralgia (PHN) (5.0%), and 38,755 (1.2%) HZ ophthalmicus (HZO) were projected over their remaining lifetime. Mass RZV vaccination reduced HZ, PHN, and HZO cases by 204,875 (−23.0%), 31,949 (−20.5%), and 8,471 (−21.9%), respectively, which was 4–5 times that reduced with ZVL. RZV was more efficient than ZVL, with lower number needed to vaccinate to prevent one HZ/PHN/HZO case (RZV: 7/40/148; ZVL: 27/163/709). Among all age cohorts, the greatest reduction in cases was projected for RZV (versus no vaccination/ZVL) in the youngest cohort, 50–59 YOA. Results were robust under scenario and sensitivity analyses. HZ burden in Hong Kong is substantial. Mass RZV vaccination is expected to considerably reduce public health burden of HZ among individuals ≥50 YOA, compared with no vaccination/ZVL. Results may support value assessment and decision-making regarding vaccination strategies for HZ prevention in Hong Kong.

Public health impact of recombinant zoster vaccine for prevention of herpes zoster in US adults immunocompromised due to cancer

ABSTRACT Individuals who are immunocompromised (IC) due to therapy or underlying disease are at increased risk of herpes zoster (HZ). This study evaluates the public health impact of recombinant zoster vaccine (RZV) relative to no HZ vaccination for the prevention of HZ among adults aged ≥18 years diagnosed with selected cancers in the United States (US). A static Markov model was used to simulate three cohorts of individuals who are IC with cancer (time horizon of 30 years; one-year cycle length): hematopoietic stem cell transplant (HSCT) recipients, patients with breast cancer (BC; a solid tumor example), and patients with Hodgkin’s lymphoma (HL; a hematological malignancy example). Cohort sizes reflect the estimated annual incidence of each condition in the US population (19,671 HSCT recipients, 279,100 patients with BC, and 8,480 patients with HL). Vaccination with RZV resulted in 2,297; 38,068; and 848 fewer HZ cases for HSCT recipients, patients with BC, and patients with HL, respectively (each versus no vaccine). Vaccination with RZV also resulted in 422; 3,184; and 93 fewer postherpetic neuralgia cases for HSCT, BC, and HL, respectively. Analyses estimated the quality-adjusted life years gained to be 109, 506, and 17 for HSCT, BC, and HL, respectively. To prevent one HZ case, the number needed to vaccinate was 9, 8, and 10, for HSCT, BC, and HL, respectively. These results suggest RZV vaccination may be an effective option to significantly reduce HZ disease burden among patients diagnosed with selected cancers in the US.

How large could the public health impact of introducing recombinant zoster vaccination for people aged ≥50 years in five Latin American countries be?

ABSTRACT This study aimed to: (1) estimate the disease burden of herpes zoster (HZ) and (2) assess the potential public health impact of introducing adjuvanted recombinant zoster vaccine (RZV) compared with no vaccination in adults aged ≥50 years in Argentina, Brazil, Mexico, Chile, and Colombia using the ZOster ecoNomic Analysis (ZONA) static multicohort Markov model. The model followed individuals aged ≥50 years from administration of RZV over their remaining lifetime. Inputs were based, most often, on local data. First dose coverage was assumed to be 35%, with 75% second dose compliance. It was predicted that without RZV, there would be 23,558,675 HZ cases, 6,115,981 post-herpetic neuralgia (PHN) cases, and 7,058,779 non-PHN complications in the five countries, but introducing RZV under assumed coverage could avoid 4,583,787 (19%) HZ cases, 1,130,751 (18%) PHN cases, and 1,373,419 (19%) non-PHN complications. Also, 10427,504 (20%) doctor’s office visits and 1,630,201 (19%) days of hospitalization could be averted in the three countries (Argentina, Brazil, and Mexico) with available input data. The numbers needed to be vaccinated to avoid one case of HZ were 9–10 across countries, and to avoid one case of PHN, 35–40. One-way sensitivity analyses showed that the input parameters with the largest impact on the estimated number of HZ cases avoided were first dose coverage, initial HZ incidence, and vaccine efficacy waning. In conclusion, the introduction of RZV for older adults in Latin America could greatly reduce the public health burden of HZ and reduce the related doctor visits and hospitalization days.

Immunogenicity and safety of the non-typable Haemophilus influenzae–Moraxella catarrhalis (NTHi-Mcat) vaccine administered following the recombinant zoster vaccine versus administration alone: Results from a randomized, phase 2a, non-inferiority trial

ABSTRACT A candidate AS01-adjuvanted vaccine containing four surface proteins from non-typable Haemophilus influenzae and Moraxella catarrhalis (NTHi-Mcat) has been developed to help prevent exacerbations of chronic obstructive pulmonary disease (COPD). Sequential administration of different vaccines containing the same AS01-adjuvant system could lead to immune interference. We compared administration of NTHi-Mcat following AS01-adjuvanted recombinant zoster vaccine (RZV) versus NTHi-Mcat alone. This phase 2a, open-label trial (NCT03894969) randomized healthy current or former smokers (50–80 years) without COPD to administration of NTHi-Mcat at 1, 3 or 6 months after RZV or to NTHi-Mcat alone (2-dose for both vaccines). Primary outcome was non-inferiority of the humoral immune response to NTHi-Mcat administered 1 month after RZV versus NTHi-Mcat alone, evaluated by specific antibody geometric mean concentration (GMC) ratio with 95% confidence intervals (CIs). The per-protocol set included 411 participants. Primary objective was met; lower limit of the 95%CI for the GMC ratio above 0.667 for all four vaccine antigens, 1 month after the second NTHi-Mcat dose. NTHi-Mcat induced similar immune response regardless of whether administered alone or 1, 3 or 6 months following RZV. Safety and reactogenicity profiles were acceptable; adverse event frequency was similar among study groups. Injection site pain was the most common symptom. No new safety concerns were identified. The study demonstrated non-inferiority of the immune response elicited by NTHi-Mcat administered sequentially to RZV versus NTHi-Mcat alone, indicating no immune interference. Starting from 1 month, no specific interval is required between RZV and NTHi-Mcat containing the same AS01-adjuvant system components in different quantities.

Assessment of Disease Burden and Immunization Rates for Vaccine-Preventable Diseases in People Living with HIV: The Korea HIV/AIDS Cohort Study.

Prophylactic immunization is important for human immunodeficiency virus (HIV)-infected patients; however, there are insufficient data on the burden of vaccine-preventable diseases (VPDs), vaccination rates, and factors influencing vaccination. The incidence and prevalence of VPDs in HIV-infected patients between 2006 and 2017 were estimated using the Korean HIV/acquired immune deficiency syndrome (AIDS) cohort database. In addition, we evaluated the vaccination rates and influencing factors for vaccination in HIV-infected patients through multilevel analysis of clinico-epidemiological factors, immune status, and psychological status. A questionnaire survey was conducted among experts to determine whether they recommend vaccination for HIV-infected patients. The incidence rates of hepatitis B virus (HBV) infection, herpes zoster, and anogenital warts were 1.74, 7.38, and 10.85 per 1,000 person-years, respectively. The prevalence of HBV infection and anogenital warts at enrollment was 4.8% and 8.6%, respectively, which increased to 5.3% and 12.0%, respectively, by 2017. In HIV-infected patients, HBV (21.7% in 2008, 56.3% in 2013, and 75.4% in 2017) and pneumococcal vaccination rates (3.0% in 2015, 7.6% in 2016, and 9.6% in 2017) increased annually, whereas the influenza vaccination rate remained similar by season (32.7 - 35.6%). In the multilevel analysis, peak HIV viral load (≥50 copies/mL: odds ratio [OR] = 0.64, 95% confidence interval [CI]: 0.44 - 0.93; reference, <50 copies/mL) was an influencing factor for pneumococcal vaccination, while nadir CD4 T-cell counts (200 - 350 cells/mm3: OR = 0.54, 95% CI: 0.38 - 0.76; <200 cells/mm3: OR = 0.89, 95% CI: 0.62 - 1.28; reference, ≥350 cells/mm3) was an influencing factor for HBV vaccination. Influenza vaccination was associated with male sex (OR = 1.94) and the number of antiretroviral therapy (ART) regimen change (OR = 1.16), but was not significantly associated with HIV viral load or CD4 T-cell counts. Most experts responded that they administer hepatitis A virus, HBV, pneumococcal, and influenza vaccines routinely, but not human papillomavirus (12.9%) or herpes zoster vaccines (27.1%). The burden of vaccine-preventable diseases was quite high in HIV-infected patients. Nadir CD4 T-cell counts, peak HIV viral loads, and the number of ART regimen change are significant factors related to vaccination. Considering the low vaccination rates for VPDs, there was a discordance between experts' opinions and real clinical practice in the medical field.

Disseminated varicella zoster virus infection following live attenuated herpes zoster vaccine: descriptive analysis of reports to Australia’s spontaneous vaccine pharmacovigilance system, 2016–2020

ObjectivesTo examine the reported incidence and features of disseminated varicella zoster virus (VZV) infection following live attenuated herpes zoster vaccine live (ZVL: Zostavax, Merck) in immunocompromised people in Australia.Design and...

Efficacy, Effectiveness, and Safety of Herpes Zoster Vaccine in Immunocompromised Patients

The varicella-zoster is a dangerous virus that has the potential to lead to many fatal conditions. People with low immune systems tend to be affected by this virus and they are more prone to HZ and its complications. This virus can't be treated with an antiviral drug as they may not respond to them. It's important to note that the live attenuated vaccine and the adjuvant recombinant subunit vaccine have different characteristics and recommended uses for individuals with compromised immune systems. This paper aims to assess these vaccines' efficacy, effectiveness, and safety in such individuals. However, autoimmune therapy may create more side effects which can be more in the injection use. In conclusion, vaccination is a measure against HZ and its complications for people with compromised immune systems. The RZV vaccine is widely regarded as the choice because it has shown effectiveness and is considered safe, for different groups of people, with weakened immune systems. For people, with slight immune-compromised, the ZVL vaccine might be a choice. However, it's crucial to assess each situation on a basis.

The acceptability of and willingness to pay for a herpes zoster vaccine: A systematic review

Patients, predominantly the elderly, with Herpes Zoster (HZ) not only suffer symptoms of the disease but also bear considerable expenses. This study systematically reviewed the acceptability of and willingness to pay for the HZ vaccine. This review was registered in PROSPERO 2023 (CRD42023403062). We used “acceptance”, “willing to pay”, and “HZ vaccine” (and variations thereof) as keywords in a systematic search for original English research articles published up to April 7, 2023. The search was conducted over Scopus, PubMed, ScienceDirect, Cochrane, and Google Scholar in accordance with PRISMA 2020 guidelines. The inclusion criteria were as follows: studies (1) that mentioned HZ vaccination, (2) related to acceptability or willingness to pay, and (3) with full texts available and peer-reviewed prior to final publication. Grey literature, letters to editors, commentaries, case reports or series, systematic reviews, meta-analyses, articles of poor quality, and articles with ambiguously defined and measured outcome variables were excluded. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to evaluate the methodological quality of the studies. Finally, the search yielded 24 studies, of which 9 were conducted in Asia, 8 in Europe, and 7 in America. General adults or patients aged 50 or older were often the target populations, for whom treatments were accompanied by healthcare providers’ recommendations. The willingness to pay and willingness to accept the vaccine ranged from $8 to $150 and 16.6% to 85.8%, respectively. Compared to the US, Asia and Europe had higher acceptance rates for HZ immunization. The most frequent excuses given for not being vaccinated are side effects, cost, lack of recommendations, anti-vaccination views, ignorance about the HZ vaccine, and the belief that one is not at risk for the disease. National campaigns should be developed to increase public awareness of HZ, and more international research should be conducted to understand the WTA and WTP for HZ immunizations.

Evaluating Potentially Inappropriate Medications in the Elderly with Seven Different Screening Tools

Introduction: We aimed to determine the rates of potentially inappropriate medications using various screening tools and also the affecting factors in elderly patients. Materials and Method: In this prospective cross-sectional study, we recorded in detail the concomitant chronic diseases, geriatric syndromes, and drugs used in elderly patients admitted to a university hospital and then assessed potentially inappropriate medications using seven different screening tools. Results: The study included 315 patients (190 female; 125 male). We evaluated potentially inappropriate medication use with the PRISCUS, EU(7), Beers 2019, STOPP v2, and TIME-to-STOP criteria and evaluated potential prescription omissions with the START v2 and TIME-to-START criteria; the resulting identified rates of PIMs were 15.9%, 45.1%, 48.9%, 44.8%, 48.3%, 73.9%, and 97.5%, respectively. The lowest value was found with PRISCUS, as it uses fewer criteria than the others. The EU(7), Beers 2019, STOPP v2, and TIME-to-STOP results were similar to one another. START v2 and TIME-to-START yielded higher outcomes than the others due to the omission of vaccines in patients. The highest outcome was found with TIME-to-START due to the omission of the herpes zoster vaccine (97.5%), which appears only in that screening tool. Potentially inappropriate medication rates increased with the number of drugs used and with the number of concomitant chronic diseases. Conclusion: This study detected potentially inappropriate medication use in approximately half of the patients with the EU(7), Beers 2019, STOPP v2, and TIME-to-STOP screening tools. There was a positive correlation between potentially inappropriate medications and polypharmacy and increased disease burden. Keywords: Potentially Inappropriate Medication List; Polypharmacy; Aged.

Can India Let Go The Opportunity To Minimize Million Shingles Cases Annually? As India Launches Shingrix Zoster Vaccine in April 2023

Chickenpox is an incredibly uncomfortable common viral disease, rarely coming to the notice for the health system. After experiencing chickenpox or exposure to the varicella zoster virus, the virus stays dormant in the human body for life. When the immune system naturally weakens due to aging or chronic diseases like cancer, cardiac failures, chronic kidney diseases and immunodeficiency disease like HIV/AIDs etc., inactive virus reactivates, causing Shingles. Commonly seen among persons over 50 years though it can occur at any age. Most people have only one episode of the illness in their lifetime, second episodes are not uncommon, and third episodes are very rare and multiple episodes are also possible. In India, we see about a million cases of Shingles each year giving an incidence of 705 per million population per year. In USA approximately 1 out of 3 people develop herpes zoster during their lifetime Shingles, and about half of people over age 80 have had shingles. Most people with shingles in every episode start with Itching, Tingling, Burning and Pain over one or two dermatome areas to be followed by rashes on 3-5th day. Associated symptoms of fever and body ache are short lived. the blisters and pimples dry, form scabs and heal in 2-3 weeks not leaving any scar, but if get infected may take longer time of 4-5 weeks. But the tingling or a pins-andneedles feeling, itching, burning, and a deep pain due to the post-herpetic neuralgia, a severe painful condition may persist for months. The rashes often follow the distribution of nerves in the skin, a pattern called a dermatome. The most common dermatome affected are on the chest and back, around one side of the waistline but can involve any area like neck, face, butts, arms, and legs. There is no cure for shingles, but treatment with antivirals to shorten the length and severity of the illness, antihistamines NSAIDS and analgesics are used to provide comfort. Fortunately, shingles is not communicable to others. This article is based on primary cases seen by the in the context of. India has 260 million adults above 50 years of age at risk of shingles and its complications and this vaccine given in 2 doses becomes a boon for such population providing protection for 10 years. Materials and Methods: Three (including autobiographical) cases author managed since 2010 to March 2023 print media message of the launch of Shingrix Zoster Vaccine Recombinant, Adjuvanted vaccine in India on Monday the 16 April 2023 for the persons over 50 years and review of the literature.

The Effect of the COVID-19 Pandemic on Vaccination Behaviour of Individuals over the Age of 65 Years in Turkey: Single-Centre Experience

The aim of this study is to evaluate the awareness of individuals over 65 years of age who have had the COVID-19 vaccine at the Samsun Research and Training Hospital and to evaluate whether the COVID-19 pandemic affected the vaccination behaviour in the geriatric age group. A total of 290 people who were vaccinated against COVID-19 at the Samsun Training and Research Hospital between 16 April 2021 and 16 April 2022 and volunteered to participate in the study were included. The questionnaire form was created by the researchers. According to the national and global guidelines, the seasonal influenza vaccine, Td or Tdap vaccines (tetanus, diphtheria, and pertussis), shingles vaccine, and pneumococcal conjugate vaccine (PCV15 or PCV20), have been recommended to all adults over the age of 65. It was questioned whether the participants had the vaccines recommended for them before and after the pandemic, if they were not vaccinated, what were the reasons, and whether the COVID-19 pandemic affected the general view on vaccination in this age group. Demographic data and comorbidities were also recorded. After each response that showed that the participant was not vaccinated, reasons were investigated with new questions to find out the causes of vaccine refusal or vaccine hesitancy. Finally, all participants were asked whether they would have the relevant vaccinations when offered. It was shown that 282 (94.3%) of the 299 people who participated in the study were considering getting a regular COVID-19 vaccine from now on, while 84.3% of the participants mentioned that the COVID-19 pandemic had a positive effect on their general vaccination behaviour. While 39 (13%) people stated that their view on vaccination was not affected by the pandemic, 8 (2.7%) people stated that it was negatively affected. The most common reason about low vaccination rates before the pandemic was a lack of enough knowledge about the recommended vaccines. The pandemic increased the vaccination awareness among the adult population. We think that vaccination rates may be improved by education of the geriatric population on this subject.

1370. The Impact of Increased Recombinant Zoster Vaccine Use on the Burden of Herpes Zoster Among Adults Aged 50 to 59 Years

Abstract Background Recombinant zoster vaccine (RZV) was approved by the Food and Drug Administration for prevention of herpes zoster (HZ) in adults aged ≥50 years in 2017 and recommended for this population by the Advisory Committee on Immunization Practices (ACIP) in 2018. Since the ACIP recommendation, vaccination rates have been increasing but are suboptimal for adults aged 50-59 years compared to adults aged ≥50 years overall. The objective of this study was to model the change in outcomes associated with improved vaccination rates in this population. Methods A multicohort Markov model was used to compare a scenario using the real-world vaccination rate for adults in the US aged 50-59 years in 2020 to a scenario assuming a higher vaccination rate based on that of adults aged 60-64 years in 2020. Outcomes, based on a lifetime horizon, included HZ cases and complications averted, quality-adjusted life-years (QALY), and costs. Model inputs, including age-specific HZ epidemiology, RZV efficacy, real-world RZV series completion, utilities, and costs (direct and indirect), were based on published literature and US sources. The size of the population aged 50-59 years was based on 2020 US census estimates. Schematic overview of Markov model structure HZ: herpes zoster; PHN: postherpetic neuralgia Results For the 43 million adults aged 50-59 years, increasing the percentage who received at least one dose of RZV from the current estimate of 7.3% in 2020 to 14.6%, assuming 80% series completion, could avoid an additional 504,468 HZ cases. An estimated additional 42,077 post-herpetic neuralgia cases and an additional 56,247 other complication cases of HZ could be avoided. Based on the estimated cases and complications avoided, an additional 5,230 discounted QALYs would be gained. Direct costs could be reduced by an additional $638 million (M) and indirect costs by $493M. With incremental vaccination costs of approximately $1,032M, from a societal perspective, cost savings of $99M would be realized. Conclusion Increasing RZV vaccination among adults aged 50-59 years could reduce the burden associated with HZ cases, complications, and result in fewer QALY losses. From a societal perspective, cost savings could be achieved in this population in addition to improved clinical outcomes. These findings demonstrate the potential value of increasing RZV vaccination for adults in the US aged 50-59 years. Disclosures David Singer, PharmD, MS, The GSK group of companies: Employed|The GSK group of companies: Stocks/Bonds Ahmed Salem, MSc, The GSK group of companies: Employed Nikita Stempniewicz, MSc, The GSK group of companies: Employed Siyu Ma, PhD, MBBS, The GSK group of companies: Grant/Research Support Sara Poston, PharmD, The GSK group of companies: Employed|The GSK group of companies: Stocks/Bonds Desmond Curran, PhD, The GSK group of companies: Employed|The GSK group of companies: Stocks/Bonds.

630. A Single-Center 10-Year Analysis of Immunizations in Heart Transplant Recipients

Abstract Background Vaccine-preventable diseases pose a risk towards heart transplant recipients on lifelong immunosuppression. Immunization rates are low (30-80%) in solid organ transplants. The aim of this study was to examine the vaccination rates in our hospital’s heart transplant recipients with a goal to expose deficiencies and formulate strategies to increase vaccination in this population. Methods This study is a single-center retrospective chart review of patients aged 18 or older who received a heart transplant between January 1, 2012 and March 31, 2022 at our institution in Temple, Texas. We documented vaccination status or seropositivity prior to or after transplant, as recommended by the American Society of Transplantation (AST) for influenza, hepatitis B, hepatitis A, measles, mumps, and rubella (MMR), 23-valent pneumococcal polysaccharide (PPSV23), 13-valent pneumococcal conjugate (PCV13), tetanus, diphtheria, and acellular pertussis (Tdap), varicella, zoster, and COVID-19 immunizations. We evaluated the association with an Infectious Disease (ID) consult. Odds ratios (OR) were calculated with 95% confidence intervals. Results 72 patients received a heart transplant within the 10-year period. Demographics are noted in table 1. Table 2 presents the immunization status as follows: 48.7% for flu vaccine, 55.5% for Hepatitis B, 47.1% for Hepatitis A, 36.1% for MMR, 67.5% for PPSV23, 67.5% for PCV13, 54.1% for Tdap, 83.3% for Varicella and 13.8% for Zoster, and 53.5% for COVID-19. From 2016, an ID consult was required pre-transplant; 45 patients (62.5%) had an ID consult before transplant. ID consult was associated with increased likelihood of receiving the MMR, PCV13, Tdap, and Zoster vaccines (table 3). Table 1Patient demographics Table 2 Immunization status in heart transplant recipients Table 3 Immunization status associated with ID consult Conclusion This study reveals the deficiency of vaccinations in our heart transplant patients, but an ID consult was associated with better immunization rates. To further increase compliance, we propose different interventions including close follow-up with ID, addressing vaccine costs, accessibility limitations, cultural hesitancy, and implementation of protocols. Disclosures All Authors: No reported disclosures.

107. Identification of state-level variables associated with changes in vaccination coverage rates in adults aged 18 to 64 in the United States

Abstract Background Despite the recognized value of life-course vaccination, adult vaccine uptake remains low. State-level vaccination coverage disparities may be associate with state-level variables (e.g., policies, programs, practices, and population characteristics). The objective of this study was to identify state-level variables associated with increased adult vaccination coverage rates (VCR) in the US for influenza, tetanus, herpes zoster (HZ), and pneumococcal vaccines over time. Methods Retrospective, exploratory database analysis of 2011-2019 Behavioral Risk Factor Surveillance System (BRFSS) data was used to calculate state-level VCRs for adults 18-64 years old. Using publicly available data, state-level variables associated with increases in VCRs were identified via a systematic variable selection. The multivariable regression models included variables meeting the criteria: correlations &amp;gt; 0.4 or &amp;lt; -0.4 (continuous) or Kruskal-Wallis Test p-value &amp;lt; 0.2 (categorical). Results Final multivariable regression models included 5 variables: Medicaid expansion status, accountable care organizations in place, health homes program, percentage of adults who report not seeing a doctor in past 12 months because of cost, and percentage of adults who report participating in any physical activity. In the multivariable models, the following state-level variables were significantly associated with changes in VCR: Influenza: percentage of adults who report participating in any physical activity (p = .01)Pneumococcal: percentage of adults who report not seeing a doctor in the past 12 months because of cost (p = .02)HZ: health homes (p = .04); percentage of adults who report participating in any physical activity or exercise (p = .01); percentage of adults who report not seeing a doctor in past 12 months because of cost (marginally significant, p = .056)Tetanus: none Conclusion Few state-level variables demonstrated an association with changes in VCR but some significant findings were observed in final models. Associated variables may not have a direct relationship but may be associated with public health infrastructure supporting vaccination ecosystems. Further research is underway to better understand the factors affecting adult vaccination. Disclosures Amanda Eiden, PhD, MBA, MPH, Merck &amp; Co., Inc.: Stocks/Bonds Mark A. Price, MA, MEd, Merck: Advisor/Consultant|Merck: I am an employee of RTI Health Solutions. Merck has contracted with my company to conduct the study described in the abstract. Alexandra Bhatti, JD, MPH, Merck &amp; Co. Inc.: Grant/Research Support|Merck &amp; Co. Inc.: Stocks/Bonds.

104. Evaluation of Vaccination Rates and Factors associated with Vaccine Uptake among People Living with HIV in Detroit, MI

Abstract Background Determination of vaccination rates for people living with HIV (PLWH) and factors that affect adherence to vaccination is important to ensure these vulnerable patients are optimally protected against vaccine-preventable diseases. We analyzed the rates of vaccination and associated factors in PLWH receiving care in the Henry Ford Health Infectious Diseases (HFH ID) Clinic in Detroit, MI. Methods We implemented a retrospective, observational study. Inclusion criteria were all PLWH who had at minimum two clinic visits at HFH ID clinic within 12 months from 2015-2021. Charts were reviewed for demographic data. We analyzed the rates of all eligible vaccines including the hepatitis A and B, HPV, influenza, pneumococcal, tetanus, zoster, and COVID-19 vaccines. Results A total of 661 met the inclusion criteria. Average age of the patients was 50 years. 78.6% were male, 74.3% black, and 57.6% patients were from Detroit. On average, patients had 1 clinic visit in the past year at HFH ID Clinic. Rates of influenza, pneumococcal, and tetanus vaccinations were above 90%. Rates of hepatitis A and B vaccinations were above 80%. Rates of zoster and HPV vaccinations were above 50%. COVID-19 vaccination had the lowest rate at 42.1%. Patients who had received all recommended vaccines were more likely to be male, have a HFH PCP, men who have sex with men (MSM), younger, more HFH ID clinic visits, and have a higher CD4 count on entry into care. Factors associated with increased vaccine uptake include having a HFH primary care physician (PCP), more HFH ID clinic visits, and a CD4 count above 200 on entry. Having 2 clinic visits in the previous year was associated with a higher likelihood of vaccine adherence [OR 5.85 (95% CI 0.360 – 0.723)]. Conclusion Our study shows that even in this highly vulnerable, vaccine-hesitant population, programs that integrate vaccines and promote adherence to clinic care into the routine care of PLWH results in high rates of vaccine uptake. Disclosures Indira Brar, MD, Gilead: Grant/Research Support|Gilead: speakers bureau|Janssen: Grant/Research Support|Janssen: speakers bureau.

639. Vaccination in Kidney Transplant Candidates

Abstract Background Kidney transplant (KT) candidates have historically low immunization rates against recommended vaccines. A retrospective study of KT candidates was conducted to assess contemporary vaccination rates and vaccine uptake during pre-transplant evaluation. Methods All KT candidates ≥ 18 years referred to Transplant Infectious Disease Clinic for pre-transplant evaluation between January 1, 2020 and August 31, 2020 were retrospectively studied for history of prior vaccination against Tdap, 13 valent pneumococcal conjugate vaccine (PCV13), 23 valent pneumococcal polysaccharide vaccine (PPSV23), Hepatitis A and B (using Hepatitis A total IgG and Hepatitis B surface antibodies as surrogate markers) and recombinant zoster vaccine (RZV). Seropositivity (as a marker of immunity) against measles, mumps, rubella and varicella was also assessed. Results 109 KT candidates were evaluated (tables 1 &amp; 2). Rates of prior vaccination against Tdap, PCV13 and PPSV23 were 33%, 58%, and 67%. Only 5 (8%) of 61 patients ≥ 50 years of age had received 2 doses of RZV. Thirty (28%) had positive Hepatitis A total IgG and 72 (66%) patients had a positive Hepatitis B surface antibody. Among 37 patients with negative Hepatitis B surface antibody, most had received at least one dose of Hepatitis B vaccine (five were non responders, 19 had had initiated the vaccine series and one had waning antibody response). 79-96% patients had immunity against measles, mumps, rubella and varicella. Patients ≥ 50 years (vs under 50 years) had numerically higher immunization rates against PCV13 and PPSV23 (67% vs 46% and 74% vs 58%) and higher rates of immunity against measles, mumps, rubella and varicella (95% vs 73%; 85% vs 69%, 95% vs 81% and 100% vs 92% respectively). Dialysis patients had a higher Hepatitis B surface antibody compared to non-dialysis patients (78% vs 39%). Only 6 of 109 patients were fully immunized. Among 103 vaccine eligible patients, 99 (96%) agreed to get vaccinated. Table 1Baseline characteristics of kidney transplant candidates Table 2 Vaccination in kidney transplant candidates Conclusion KT candidates have low rates of prior immunization against Tdap, PCV13, PPSV23, Hepatitis A and B and RZV but high rates of serological immunity against measles, mumps, rubella and varicella. The vaccine uptake during pre-transplant evaluation was high and it provides an unique opportunity to improve immunization in this population. Disclosures All Authors: No reported disclosures.

114. Long-term Protection Against Herpes Zoster (HZ) by the Adjuvanted Recombinant Zoster Vaccine (RZV): Interim Efficacy, Immuno and Safety Results at Approximately 10 Years after Initial Vaccination

Abstract Background For the first time, we present data describing vaccine efficacy (VE), immunogenicity persistence and safety up to approximately 10 years after primary vaccination against HZ with RZV. We have previously shown that RZV demonstrated high VE against HZ in adults ≥ 50 years of age (YOA) participating in 2 phase 3 clinical trials (ZOE-50, NCT01165177 and ZOE-70, NCT01165229), and VE persisted up to year (Y) 2 in the interim analysis of the extension study (ZOSTER-049, NCT02723773). Here we describe the interim analysis for Y4 of the extension study. Understanding the persistence of VE and long-term protection against HZ can help to optimize the use of RZV in adults ≥ 50 YOA. Methods The study design is detailed in Figure 1. Primary objective included VE against HZ over the ZOSTER-049 study. Secondary objectives included VE against HZ from 1 month post-dose 2 in the ZOE-50/-70 studies until the end of Y4 of ZOSTER-049 (Y10 after vaccination), persistence of vaccine-induced humoral immunogenicity (HI) in terms of anti-glycoprotein E (gE) antibody and cell-mediated immune (CMI) response in terms of frequency of gE-specific CD4[2+] T-cells and safety. VE analysis for ZOSTER-049 used historical control estimates from the ZOE-50/-70 placebo groups. Results In ZOSTER-049, 7,413 participants were enrolled and 7,277 were included in VE analysis (Figure 2). During 4 years of follow-up in ZOSTER-049, overall VE against HZ was 81.6% (95% confidence interval [CI]: 75.2–86.6). From 1 month post-dose 2 in ZOE-50/-70 until Y4 of ZOSTER-049, the overall VE was 89.0% (95% CI: 85.6–91.3). In ZOSTER-049, anti-gE antibody concentrations persisted &amp;gt; 5 times above pre-vaccination up to Y10 after vaccination (Figure 3A). The frequency of gE-specific CD4[2+] T-cells remained above pre-vaccination from Y6 to Y10 after vaccination (until the end of Y4 of ZOSTER-049) (Figure 3B). No safety signals were identified until the end of Y4 of ZOSTER-049. Conclusion Efficacy against HZ and immune responses to RZV remained high until the end of the observation period for this Y4 interim analysis suggesting that the clinical benefit of the RZV in adults ≥ 50 YOA is sustained for at least 10 years after vaccination. RZV safety profile remained clinically acceptable. Funding GlaxoSmithKline Biologicals SA Disclosures Ana Strezova, MD, MSc, GSK: I am an employee of GSK group of companies and hold shares from GSK group of companies as part of my employee remuneration Javier Diez-Domingo, MD, PhD, GSK: Grant/Research Support|GSK: Honoraria|MSD: Advisor/Consultant|MSD: Grant/Research Support|MSD: Consulting fees to the author and his institution|SANOFI: Advisor/Consultant|SANOFI: Grant/Research Support|SANOFI PASTEUR: Consulting fees to the author and his institution|SEQIRUS: Honoraria|SEQIRUS: Honoraria to the author and his institution Kamal Al Shawafi, MD, Modis: I am an employee of Modis, working on behalf of the GSK group of companies Juan Carlos Tinoco, MD, GSK: Grant/Research Support Meng Shi, MS, GSK: I am an employee of GSK group of companies Paola Pirrotta, n/a, GSK: I am an employee of GSK group of companies and hold shares from GSK group of companies as part of my employee remuneration Agnes Mwakingwe-Omari, MD/PhD, GSK: I am an employee of GSK group of companies.

Genetic analysis of varicella-zoster virus in patients with viral anterior uveitis

Objective: To analyze the intraocular varicella-zoster virus (VZV) infection and genetic characteristics in patients clinically diagnosed with viral anterior uveitis. Methods: A total of 83 aqueous humor samples were collected from patients clinically diagnosed with viral anterior uveitis infection in China from June 2018 to July 2019. The positive samples infected with VZV were screened by real time polymerase chain reaction, and the single nucleotide polymorphisms on the open reading frames 22, 38 and 62 of the positive samples were amplified and analyzed. According to the gene characteristics of the amplified target fragment, the vaccine strain and wild strain (8 vaccine strains and the rest were wild strains) were identified to determine the genotype. Results: There were 83 patients (31 females and 52 males) with viral uveitis infection, whose mean age was 51.0 (45.5, 61.0) (range: 15-83) years,, and, of which 57.8% (48 cases) were infected with viral uveitis over 50 years of age. None of the patients had a history of varicella or herpes zoster vaccination. Of the samples of 83 patients infected with viral uveitis, 57 (68.6%) were positive for VZV. Among them, 14 were successfully amplified to obtain the target fragment gene sequences, all of which were wild strains by analysis, and belonged to Clade2 of genotype, which was the same as the VZV vaccine strain types infected by varicella and herpes zoster patients in China. Conclusion: From 2018 to 2019, VZV infection in Chinese patients with viral anterior uveitis was a wild strain, and the genotype belonged to Clade2 as the vaccine strain, which was the same as the main epidemic genotype of VZV infection in Chinese patients with varicella and herpes zoster.

Longitudinal changes in cell-mediated immunity after varicella-zoster virus skin test in the general population; Shozu Herpes Zoster Study: SHEZ study.

Varicella-zoster virus-specific cell-mediated immunity has been associated with the onset and severity of herpes zoster (HZ), and the administration of the HZ vaccine enhanced the immunity. However, limited data is available on the duration of cell-mediated immunity enhancement by soluble antigen of varicella-zoster virus (VZV) skin test. A prospective, community-based cohort study was conducted in Shozu County, Kagawa Prefecture, Japan. Repeated VZV skin tests containing inactivated VZV antigen and blood tests were performed on 365 subjects aged 60 years and older at baseline, 1, 2, and 3 years later. The differential immunity indices of VZV over time for cell-mediated and humoral immunity were evaluated.VZV skin test reaction and ELISpot counts increased significantly at 1, 2, and 3 years later compared to the baseline. However, humoral immunity indices did not change materially over time. Soluble antigen by VZV skin test enhanced VZV-specific cell-mediated immunity, and it persisted for at least 1 year. In addition, the inoculation with inactivated antigens every year by VZV skin test continued to enhance VZV-specific cell-mediated immunity after 2 and 3 years.

Risk of, and risk factors for, vasculopathy associated with acute herpes zoster

ObjectivesWe aimed to summarize the known risk of vasculopathy (stroke, myocardial infarction [MI], and transient ischemic attack [TIA]) after herpes zoster (HZ) and the impact of antiviral treatment and vaccination against HZ on the risk of vasculopathy. Materials and methodsA narrative literature review was conducted in PubMed to identify evidence published in the past 15 years that was relevant to the scope of this article. ResultsTen studies reported that HZ was associated with an increased risk of stroke and one UK study reported no association. Four studies reported that HZ was associated with an increased risk of MI, and four reported that HZ was associated with an increased risk of TIA. Two studies reported that antiviral treatment was associated with a reduced risk of stroke and an additional two studies reported no association between antiviral treatment and the risk of stroke. In addition, two studies reported that vaccination against HZ using the live zoster vaccine (ZVL) was associated with a reduced risk of stroke, and an additional two studies reported that the risk of stroke or MI after HZ was similar between ZVL vaccinated and unvaccinated individuals. ConclusionsHZ is associated with an increased risk of stroke, MI, or TIA (strongest association is between HZ and stroke). Further studies are needed to determine whether antiviral treatment or ZVL vaccination influence the risk of HZ-associated vasculopathy. In addition, the effect of the recombinant zoster vaccine on the risk of HZ-associated vasculopathy should be studied.