Zoster Vaccine Research Articles

Improving precision of vaccine efficacy evaluation using immune correlate data in time-to-event models.

Understanding potential differences in vaccine-induced protection between demographic subgroups is key for vaccine development. Vaccine efficacy evaluation across these subgroups in phase 2b or 3 clinical trials presents challenges due to lack of precision: such trials are typically designed to demonstrate overall efficacy rather than to differentiate its value between subgroups. This study proposes a method for estimating vaccine efficacy using immunogenicity (instead of vaccination status) as a predictor in time-to-event models. The method is applied to two datasets from immunogenicity sub-studies of vaccine phase 3 clinical trials for zoster and dengue vaccines. Results show that using immunogenicity-based estimation of efficacy in subgroups using time-to-event models is more precise than the standard estimation. Incorporating immune correlate data in time-to-event models improves precision in estimating efficacy (i.e., yields narrower confidence intervals), which can assist vaccine developers and public health authorities in making informed decisions.

Optimal timing of recombinant herpes zoster virus vaccination for a JAK inhibitor treatment in rheumatoid arthritis: a multicentre, open-label, randomised comparative study (STOP-HZ study): study protocol

IntroductionJanus kinase (JAK) inhibitors are an important therapeutic option in the treatment of rheumatoid arthritis, but increase the risk of developing herpes zoster. Although a dry recombinant zoster vaccine (RZV) that can be used under immunosuppressive conditions has recently been developed, its optimal use and appropriate timing in patients scheduled to start JAK inhibitors is still unclear. The present study is designed to clarify the appropriate timing of JAK inhibitor initiation to measure varicella zoster virus (VZV)-specific IgG titers and VZV-specific T cell response in patients with rheumatoid arthritis who start tofacitinib at the first RZV vaccination or at the second one.Methods and analysisSTOP HZ (Effectiveness andSafeTyOfProphylactic RecombinantHerpesZoster Virus Vaccination for Rheumatoid Arthritis Patients with Tofacitinib Treatment) study is a multicentre, open-label, randomised, comparative study in patients with rheumatoid arthritis who are scheduled to start tofacitinib. This study enrols 60 study subjects in 12 sites. Enrolled subjects receive RZV two times on day 1 and week 8 and initiate tofacitinib 5 mg two times a day at the time of their first RZV (day 1, group A) or second RZV (week 8, group B) based on randomisation. The random assignment is performed centrally in a 1:1 ratio. Patients in Group B continue the same treatment until the start of tofacitinib treatment. Primary endpoint is VZV-specific IgG antibody titers at week 12 compared with those at baseline in each group. Secondary endpoints include comparison of VZV-specific IgG antibody between the groups, changes in disease activity of rheumatoid arthritis, VZV-specific T cell response and adverse events.Ethics and disseminationThe study has been approved by the Certified Review Board of Keio (No. 2022008), and conforms to the Declaration of Helsinki and good clinical practice guidelines. Written informed consent is obtained from participants prior to enrolment. The results of this study are planned to be submitted for publishment in relevant peer-review journals.Trial registration numberjRCTs031230329.

The role of sociodemographic factors on herpes zoster vaccine uptake among hard-to-reach populations

Abstract Background The anti-Herpes Zoster (HZ) vaccination program was expanded with the adjuvated recombinant vaccine (HZR) in the Lazio Region, Italy, in 2022, restricting its use only to certain categories at risk due to pathological conditions, such as dialysis patients or immunocompromised individuals. This study focuses on the role of clinical and socio-demographic factors on HZR vaccine uptake within the fragile resident population of the Local Health Authority Rome 2 (ASL RM2). Methods This population-based, retrospective cohort study leveraged data from various registries and databases. The study population comprised 835,779 individuals aged ≥18 years who were both RM2 residents and registered with an RM2 general practitioner (GP). Among these, 143,242 individuals with at least one chronic condition were assessed for vaccination uptake using a multivariate logistic model, exploring associations with gender, age, nationality, marital status, household size, and level of deprivation. Results At the conclusion of the study period, a small fraction (1.5%) of the fragile subjects had received at least one dose of the HZR vaccine, and a majority (78%) completed the vaccination course of two doses. The analysis indicated that vaccine adherence was significantly higher in males (OR = 1.15) and individuals aged 65 + (OR = 1.13) while lower among residents in areas of medium (OR = 0.61) and high deprivation (OR = 0.44) and with specific living arrangements - widowed people living alone (OR = 0.66) and families ≥ 6 people (OR = 0.63). Conclusions The ASL RM2 vaccination strategy for hard-to-reach individuals includes an integrated approach, with the engagement of local healthcare facilities and hospitals. Despite these efforts, lower adherence in socioeconomically disadvantaged fragile patients suggests a pressing need for targeted communication strategies and interventions to ensure equitable access to the HZ vaccine, as these groups are more vulnerable to developing chronic diseases. Key messages • Socio-demographic factors significantly influence Herpes Zoster vaccine uptake in hard-to-reach populations, with lower adherence in socially deprived groups. • Tailored, equity-driven approaches are essential for enhancing vaccine coverage among hard-to-reach fragile individuals, mitigating the higher disease risks in these communities.

Organizational barrier to herpes zoster vaccination uptake in Europe: a systematic review

Abstract Background The Herpes Zoster virus represents a significant public health threat for unvaccinated frail individuals and older adults, aged 50 or older. Globally, 95% of elderly and frail individuals are susceptible to develop Herpes Zoster as already being exposed to Varicella Zoster Virus. Organizational and logistical barriers, such as cost management, vaccine storage requirements, supply limitation, logistic difficulties, absence of a streamlined collection system, and healthcare system deficiencies might reduce vaccination uptake. Methods A systematic review was conducted to identify studies published in the last 10 years, and focused on logistic and organizational barriers for Herpes Zoster vaccination uptake among frail and participants aged 50+ in Europe. Prisma guidelines were followed, and AXIS tool was used to evaluate the risk of bias. Results After a thorough analysis, 4 studies were selected from a total of 863 for detailed review. The analysis revealed several barriers to vaccination uptake, including challenges involving healthcare professionals, participant-related obstacles concerning perceptions and knowledge, accessibility issues, structural deficiencies, and social dynamics. A significant barrier identified is the perception among participants that general practitioners either do not support the vaccination or that participants themselves underestimate the risk of developing Herpes Zoster. Additionally, current communication strategies have proven inadequate, indicating a need for more effective and updated approaches to increase public awareness. These factors contribute to hesitancy regarding vaccination. Conclusions This study provides a comprehensive examination of the organizational and logistical barriers to the Herpes Zoster vaccination uptake. Tailored interventions are essential to overcome these barriers. Successfully addressing these challenges might enhance vaccination rate and reduce the public health burden associated with Herpes Zoster. Key messages • Several logistic and organizational barriers reduce the Herpes Zoster vaccination uptake. • Further literature is required to understand how to overcome those barriers, and increase vaccination uptake.

Polymyalgia rheumatica following COVID-19 vaccination: Case series of 3 patients and literature review on polymyalgia rheumatica induced by various vaccines.

Since the onset of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic in 2019, considerable resources have been devoted to developing vaccines to reduce related deaths and the burden of disease. Various vaccine formulations eventually became available and were approved for clinical use. In this article, we have conducted a review of polymyalgia rheumatica (PMR) cases induced by different COVID-19 vaccines [Pfizer: BNT162b2, AstraZeneca: ChAdOx1-S, Moderna: mRNA-1273, and Janssen: Ad26.COV2.S)], as well as non-COVID-19 vaccines, such as influenza, zoster, hepatitis B, and tetanus vaccines. Additionally, this article investigates 3 cases with clinical presentations suggestive of PMR following COVID-19 mRNA vaccination. This study aims to offer valuable insights through sharing diagnostic and therapeutic experiences. Three patients presented with severe pain and stiffness in both shoulder and pelvic girdle muscles, following COVID-19 mRNA vaccination. Clinical presentations, laboratory parameters, and echographic findings confirmed the diagnosis of PMR following COVID-19 mRNA vaccination. Patients received Prednisone and/or Methotrexate adjusted to body weight. Polymyalgia rheumatica resolved successfully without any adverse events. Although direct causality was not definitively established in this article, the BNT162b2 COVID-19 mRNA vaccine, similar to other vaccines, might be considered a potential trigger for PMR. This raises the need for further research into this issue and potentially other immunological outcomes.

Immunogenicity and Safety of the Recombinant Adjuvanted Herpes Zoster Vaccine in Patients with Chronic Lymphocytic Leukemia and Multiple Myeloma

Background/objectives: Patients with chronic lymphocytic leukemia (CLL) and multiple myeloma (MM) are susceptible to viral infections, including varicella-zoster virus (VZV) reactivation due to both disease-related and treatment-induced immunosuppression. The recombinant adjuvanted herpes zoster vaccine (RZV) has shown high efficacy in immunocompetent adults, but immunogenicity data in CLL and MM patients are limited. This study evaluates the immunogenicity and safety of RZV in this population. Methods: Patients with CLL and MM vaccinated with RZV (administered in two doses at least one month apart) were included in the study. Pre- and post-vaccination anti-VZV IgM and IgG antibody levels were measured to assess immunogenicity, and adverse events (AEs) were captured for safety evaluation. Results: Seventy-eight patients received both vaccine doses, and 71 had post-vaccination samples. Most of the patients were IgM seronegative and IgG seropositive before vaccination. Pre-vaccination IgG levels were higher in CLL patients compared to MM patients (p = 0.001), while post-vaccination IgG levels significantly increased in both CLL (p < 0.0001) and MM (p < 0.0001) patients. In actively treated CLL patients, pre-vaccination IgG levels were significantly lower than in not actively treated patients (p = 0.002). Post-vaccination IgG levels were lower in MM patients receiving antiviral prophylaxis concurrently with the vaccination (p = 0.013). AEs were reported in 49.4% of patients after the first dose and 48.7% after the second dose, mostly mild (local or low-grade systemic). One case of immune thrombocytopenia was noted. Conclusions: RZV demonstrated strong immunogenicity and acceptable safety in CLL and MM patients, significantly boosting IgG levels, even in actively treated or heavily pretreated patients.

Patients with Inflammatory Bowel Disease are at Increased Risk for Complications of Herpes Zoster

Background and aimsPatients with inflammatory bowel disease (IBD) are at an increased risk for vaccine-preventable diseases, such as herpes zoster (HZ). The aim of this study was to determine whether complications of HZ are more frequent in patients with IBD than in non-IBD controls. MethodsThis was a retrospective, cohort study using the Optum Research Database. Patients with IBD were matched 1:1 to non-IBD controls based on age, sex, and index year, which was defined as the diagnosis of HZ. We then identified the complications of HZ that occurred up to 90 days after the index date. We compared patients with IBD with non-IBD controls and evaluated the 90-day risk of HZ complications. We used a composite primary outcome for any HZ complication. Secondary outcomes were risk factors for complications. ResultsFour thousand seven fifty-six patients with IBD met the inclusion criteria and were matched to the controls. Patients with IBD were more likely to have complications of HZ than controls [738 (15.52%) vs. 595 (12.51%), p < 0.0001]. Patients with IBD with higher comorbidity scores were more likely to develop complications (1.86 vs. 1.18 p < 0.0001). In the logistic regression analysis of patients with IBD having a higher comorbidity score, above 50 years of age, on anti-TNF or corticosteroids were all at increased risk of a complication of HZ. ConclusionPatients with IBD are more likely to have complications of HZ than controls. Efforts are needed to increase HZ vaccine uptake to reduce the morbidity of HZ.

Exploring the association between chronic prostatitis and the risk of herpes zoster in a cohort study in Taiwan.

The aim of the cohort research was to study the association between chronic prostatitis and the probability of herpes zoster in Taiwan. Using the National Health Insurance Research Database (NHIRD) of Taiwan, we selected male persons newly diagnosed with chronic prostatitis aged 20-84 years between 2013 and 2020. These male persons were then matched with a non-prostatitis group who did not have a diagnosis of prostatitis by using 1:1 propensity score matching on age and relevant comorbidities. All participants were observed either until a new diagnosis of herpes zoster was noted or until the completion of the study period in 2020. Cox proportional hazards regression analysis was employed to study the hazard ratio (HR) and 95% confidence interval (CI) for the risk of herpes zoster associated with chronic prostatitis. A total of 69 239 participants with chronic prostatitis and 69 239 participants with non-prostatitis were included in the analysis. The incidence rate of herpes zoster was higher in participants with chronic prostatitis compared to the non-prostatitis group (8.03 per 1000 person-years for chronic prostatitis group versus 4.74 per 1000 person-years for non-prostatitis group, incidence rate ratio = 1.69, and 95%CI = 1.59-1.81). After adjusting for co-variables, participants with chronic prostatitis were found to have a higher risk of developing herpes zoster compared to the non-prostatitis group (adjusted HR = 1.69, 95%CI = 1.59-1.81, and p < 0.001). This cohort research suggests that people with chronic prostatitis may have a greater risk of developing herpes zoster compared to the non-prostatitis group in Taiwan. Preventive strategies, such as the administration of the herpes zoster vaccine, might be beneficial in people with chronic prostatitis.

A Survey on Knowledge and Attitudes Towards Vaccination Against Herpes Zoster Virus Among Medical Oncologists for Patients with Solid Tumors.

Herpes zoster (HZ) virus reactivation is a significant medical problem among immunocompromised patients, especially considering its potential complications. Although the recombinant HZ vaccine has demonstrated > 90% efficacy against HZ in adults, its use is not as frequent as needed in daily oncology practice due to several barriers, including oncologists' knowledge, patients' willingness, and organizational issues. A web-based survey was sent to 139 oncologists treating solid tumors concerning their knowledge and attitudes toward the adjuvanted gE-based recombinant HZ vaccination. The survey included questions regarding the characteristics of medical oncologists participating, such as the type of hospital, main field of expertise, percent of work with patients, awareness of the HZ risk in cancer patients, knowledge of scientific data and scientific societies guidelines on HZ vaccination, familiarity with vaccinations, frequency of HZ detection in clinical practice, barriers, and challenges toward vaccine administration. Fifty-four physicians (46%; 95% CI 0.2918 to 0.5069) responded to all the questions. The main reason for non-response was the lack of time due to the overwhelming burden of assistance. When the survey was launched, 31 participants reported good knowledge of scientific and clinical data of HZ vaccines, 10% none, and 36 were aware of guidelines. Reported barriers included knowledge of the problem, patients' willingness, and organizational issues. Surveying medical oncologists on the adjuvanted gE-based recombinant HZ vaccination provides essential insights into their knowledge, attitudes, and practices regarding vaccination for cancer patients. These data suggest that continuing medical education is necessary to implement HZ vaccination prescription among oncologists.

Case Report: Emergence of de novo Donor-Specific HLA antibodies post Pneumococcal &amp; Varicella Zoster Vaccinations in Waitlisted Renal Transplant Candidate

Abstract Introduction/Objective In renal transplant waitlisted patients, vaccination series remains to be the standard of care for infection prevention. There is a need to investigate if any of these vaccines or their adjuvant components can induce de novo donor-specific antibodies (dnDSA) against human leukocyte antigens (HLA). These novel anti-HLA antibodies in renal transplant waitlisted patients can result in a positive flow cell crossmatch (FCXM) associated with an increased risk of renal transplant rejection. Methods/Case Report We present a 59-year-old renal transplant waitlisted patient who has had multiple negative T- cell and B-cell FCXM with no detection of dnDSA at baseline. We detected de-novo anti-HLA antibodies after he received pneumococcal conjugate (Pneum-C-13) and recombinant zoster vaccine (RZV). After vaccination, FCXM was positive for both T-cells and B-cells. HLA class I antibodies (A1, 23, 24, 80; B44, 45, 76) showed a panel reactive antibody (PRA) of 51%. Epitope analysis highlighted 166DG and 166ES as shared epitopes responsible for the entire specificity. The A1 dn-DSA had a mean fluorescence intensity (MFI) of 1800 and with shared A80 epitope MFI was 15,000 contributing to the strong positivity observed in T-cell and B-cell FCXM. New onset A1, and B44 DSA predicted high risk for transplant rejection with his sibling. His planned live donor renal transplant was halted and had to instead enter the kidney-paired donor program wherein he received his transplantation after 16 months. Results (if a Case Study enter NA) NA Conclusion Allosensitization risk secondary to RZV or Pneum-C-13 vaccines or their adjuvant components in renal transplant waitlisted patients must be considered as a potential risk for transplant rejection. Future studies can utilize monitoring of HLA-specific memory B-cells to provide crucial insights into the primary mechanism of action of dn-DSA anti-HLA antibody formation and suggest interventions to mitigate this memory B-cell activation.

Pay more attention to vaccination to protect the health of the elderly

Vaccination has been implemented as a priority measure to control infectious diseases worldwide. The aging of the global population continues to intensify, and the process and level of aging in China are more prominent. As age increases, the immune function of people gradually declines, and the consequences of infectious diseases such as influenza, pneumococcal disease, and shingles are more severe in the elderly, which can exacerbate existing underlying diseases, leading to higher medical costs. In the process of achieving healthy aging, it is very necessary to protect vulnerable elderly people through vaccination. Despite the undeniable protective effects of the influenza, pneumococcal, and shingles vaccines for the elderly, coupled with excellent safety and significant health economic benefits, the current vaccination rates for these vaccines among the elderly in China remain low. Some factors, such as insufficient awareness of the necessity of vaccination, concerns about vaccine adverse reactions, lack of systematic and effective recommendations, and imperfect accessibility of vaccination services, affect the popularization of preventive vaccination among the elderly in China. This situation urgently calls for the attention of society as a whole, in order to maximize the role of vaccines in safeguarding the health of the elderly.

Varicella zoster infection in Pediatric oncology patients in Hue Central Hospital, Vietnam

Abstract Background Varicella zoster infection in pediatric oncology patients presents a big challenge. It could lead to a severe, prolonged and disseminated infection with complications in multiple organs. This study aimed to investigate varicella zoster infection in pediatric oncology patients at Hue Central Hospital, Vietnam in order to describe demographic, epidemiological, clinical features and complications. Methods Varicella zoster infections among children with cancer were identified between January 8 to November 4, 2023, at Hue Central Hospital. Varicella zoster infection was diagnosed clinically based on the presence of typical skin manifestations. Data were abstracted from patient medical records and analyzed in SPSS v.18.0 (IBM Corp., Armonk, NY, USA). Results From January 8 to November 4, 2023, a total of 20 patients with malignancies were identified as having varicella zoster, with a median age of 3.5 years (range: 1 years to 16 years). All these patients did not received varicella zoster vaccine. Almost half of the patients had solid tumor (n=11, 55.0%), and other half had leukemia (n=9, 45.0%). Some of them (n=7, 35.0%) were receiving chemotherapy, and other (n=13, 65%) just finished chemotherapy. Most children were hospitalized (n=16, 80.0%) and they were given oral acyclovir (n=18, 90.0%). Three children (15.0%) required critical care (severe infection, acute pancreatitis, and multiorgan failure (MOF)), and one (5.0%) died from disseminated and progressive varicella with MOF and suspected varicella zoster meningitis. Chemotherapy was delayed or omitted due to varicella in 70.0%. Some of the children with varicella acquired from their parents. There were 5 parents who got varicella zoster when taking care patients at the hospital. All patients were likely to expose other patients in the wards. Conclusion Children with cancer are at extra risk of varicella zoster infection and progression to severe disease due to their immunocompromised status. Optimizing vaccination of care providers, such as their relatives, will prevent transmitting virus to the patients.

Prolonged Neurological and Musculoskeletal Symptoms Following Shingrix Vaccination

Background: The recombinant zoster vaccine (Shingrix) helps prevent shingles and its complications in adults 50 and older. While minor side effects are common, severe adverse reactions are thought to be rare, and long-term side effects are not well documented. Case Presentation: A 50-year-old woman with Crohn’s disease developed joint pain, effusion, and neurological symptoms such as numbness and tingling shortly after receiving the first dose of the recombinant zoster vaccine. Symptoms waxed and waned but persisted for over a year despite anti-inflammatories and specialist referrals. Diagnostic imaging and labs were unrevealing. Conclusions: This case of prolonged somatic and neurological symptoms associated temporally with Recombinant zoster vaccine administration reinforces the critical need for thorough pharmacovigilance and investigation of possible long-term adverse vaccine reactions. Provider documentation and reporting of individual experiences can help improve the detection of rare vaccine-related risks, elucidate potential risk factors, and refine safety screening. Diligent monitoring and research into longitudinal vaccine outcomes remain paramount, especially following recent emergency authorizations.

Herpes zoster development in living kidney transplant recipients receiving low-dose rituximab.

We evaluated whether a history of low-dose rituximab treatment affected herpes zoster development after living kidney transplantation. We enrolled 103 living kidney transplant recipients. Patients were divided into two groups according to their history of rituximab treatment; rituximab was administered to 50 living kidney transplant recipients. We assessed the difference in herpes zoster events between the two groups and determined the risk factors for herpes zoster using multivariate regression analysis. The total dose of rituximab in each kidney transplant recipient who received rituximab therapy was 200-400 mg. The rate of herpes zoster events after transplantation in recipients who received rituximab therapy (4 of 50, 8%) was not higher than that in recipients who did not receive rituximab (9 of 53, 17%) (p = 0.238). Herpes zoster-free survival did not significantly differ between the two groups (p = 0.409). In the multivariate regression analysis, the association between varicella zoster vaccination before transplantation and herpes zoster events after transplantation was confirmed, whereas rituximab therapy was not associated with herpes zoster events. Low-dose rituximab therapy in kidney transplant recipients did not influence herpes zoster development after transplantation. Varicella zoster vaccination before transplantation may play an important role in preventing herpes zoster after transplantation.

7809 Role Of Education In Enhancing Preventative Vaccine Awareness Among Patients With Type 2 Diabetes Mellitus In Saudi Arabia

Abstract Disclosure: S.F. Alqifari: None. T. Alrasheed: None. O. Al Komi: None. P. Amirthalingam: None. M.A. Muqresh: None. H.R. Hamad: None. A.A. Khojah: None. N.M. Alshehri: None. B.A. Alhunayhani: None. B.M. AbuAlhasan: None. N.A. Alajlan: None. S.M. Alatawi: None. N.M. Alsabeelah: None. A.S. Wasel: None. Role of Education in Enhancing Preventative Vaccine Awareness among Patients with Type 2 Diabetes Mellitus in Saudi Arabia Abstract Background: Type 2 diabetes mellitus is a major chronic disease that requires lifelong management. It requires multidisciplinary efforts from physicians, pharmacists, dieticians, and diabetic educators. Awareness of the importance of follow-up, management, and preventive vaccination decreases the burden of possible complications. The impact of the level of education of patients with diabetes and awareness of preventive vaccination in Saudi Arabia is unclear. Objectives: This study aims to understand the association of the level of education with preventative vaccine awareness in patients with type 2 diabetes mellitus in Saudi Arabia. Methods: This is an observational retrospective study where the data was collected from 13 diabetes center records in Saudi Arabia from November 2022 to May 2023, the records include education level and vaccination reports among 709 patients with type 2 diabetes mellitus. Results: Participants in this study were between the ages of 46 to 65. Participants aged 18 to 25 and 36 to 45 accounted for 24.3% and 16.2% of the participants, respectively, while those aged 26 to 35 and above 65 represented 11.6% and 5.6% of the participants, respectively. In terms of gender distribution, there were slightly more female participants (55.7%) than male participants (44.3%). Most participants (55.9%) held a bachelor's degree, followed by individuals who had completed school education (31.73%). A smaller proportion had post-graduate education (7.3%) or education levels below primary school (5.1%). Regarding vaccination status, a significant proportion of participants (85.89%) had received the COVID-19 vaccine, while the percentages for other vaccines were lower, such as Influenza (34.83%), Hepatitis B (7.19%), and Pneumococcal (3.94%). A small number of participants reported receiving the Herpes Zoster (2.96%), Tdap (2.11%), or HPV (1.12%) vaccines, and surprisingly, 10.01% of participants reported never receiving any vaccines. Conclusion: The level of education among individuals with type 2 diabetes in Saudi Arabia impacted their uptake of preventive vaccinations. Most participants were vaccinated against COVID-19, followed by influenza, while the rate of other vaccines remained low. These findings highlight the need to increase awareness and education among type 2 diabetes patients regarding the importance of seeking necessary preventive vaccinations. Presentation: 6/3/2024

Evaluation of the Recombinant Zoster Vaccine Campaign Targeting Healthcare Professionals for Shingles Prevention Awareness in India

Evaluation of the Recombinant Zoster Vaccine Campaign Targeting Healthcare Professionals for Shingles Prevention Awareness in India

Risk Factors for the Development of Ocular Complications in Herpes Zoster Ophthalmicus and Zoster Vaccine Utilization in a Large, Urban Health System

To characterize the epidemiology of herpes zoster (HZ) and herpes zoster ophthalmicus (HZO) in an urban hospital system and determine risk factors associated with developing ocular complications in HZO. To report the frequency of shingles vaccination and HZ reactivation following shingles vaccination in this population. A retrospective cohort study was conducted on patients seen at the University of Illinois Hospital system from January 1, 2010 to December 1, 2021 with HZ and HZO identified by diagnosis code. Charts of HZO patients seen within 1 year of diagnosis were abstracted. Multivariable logistic regression analysis identified factors associated with the development of ocular complications in HZO. During the study period, 3283 patients had HZ; mean age of onset was 52.3 years, 61.6% were female, and 37% were Black. HZO with ocular involvement was seen in 110 (3.4%) patients. Ocular complications developed in 40 (36.4%) patients; the most common complication was corneal scarring (70%). Age (odds ratio [OR] 1.04, 95%CI 1.0-1.1), female gender (OR 2.86, 95%CI 1.0-8.1), steroids at initial visit (4.46, 95%CI 1.4-14.6), and stromal keratitis (OR 3.45, 95% CI 1.2, 9.8) were associated with developing ocular complications. Of eligible populations, 5333 (1.5%) received shingles vaccination; 43 patients developed reactivation of HZ following vaccination. In HZO, age, female gender, steroids at initial visit, and stromal keratitis are strongly associated with developing ocular complications. Shingles vaccination rates were low in this study population. Understanding potential for complications in HZ/HZO and vaccination uptake can help identify at risk populations to prevent disease.

Safety of Simultaneous Vaccination With Adjuvanted Zoster Vaccine and Adjuvanted Influenza Vaccine

Quadrivalent adjuvanted inactivated influenza vaccine (aIIV4) and adjuvanted recombinant zoster vaccine (RZV) contain novel adjuvants. Data are limited on the comparative safety, reactogenicity, and health-related quality of life (HRQOL) effects of the simultaneous administration of these vaccines. To compare the safety and reactogenicity after simultaneous doses of RZV and aIIV4 administration (opposite arms) with simultaneous doses of RZV with quadrivalent high-dose inactivated influenza vaccine [HD-IIV4]). This randomized blinded clinical trial was conducted during the 2021-2022 and 2022-2023 influenza seasons at 2 centers in the US among community-dwelling adults aged 65 years or older. Analysis was performed on an intention-to-treat basis. Simultaneous intramuscular administration of RZV dose 1 and aIIV4 or HD-IIV4 in opposite arms after age stratification (65-69 and ≥70 years) and randomization. The primary outcome was the proportions of participants with 1 or more severe solicited reactions during days 1 to 8, using a noninferiority test (10% noninferiority margin). Additional measures included serious adverse events and adverse events of clinical interest during days 1 to 43 of the study period. A total of 267 adults (median age, 71 years [range, 65-92 years]; 137 men [51.3%]) were randomized; 130 received simultaneous RZV and aIIV4, and 137 received simultaneous RZV and HD-IIV4. The proportion of patients reporting 1 or more severe reactions after simultaneous administration of RZV and aIIV4 (15 of 115 [11.5%]) was noninferior compared with simultaneous RZV and HD-IIV4 (17 of 119 [12.5%]) (absolute difference, -1.0% [95% CI, -8.9% to 7.1%]). There were no significant differences in the number of serious adverse events or adverse events of clinical interest between the groups. In this clinical trial of simultaneous doses of RZV and aIIV4 compared with simultaneous doses of RZV and HD-IIV4, overall safety findings were similar between groups. From a safety standpoint, this study supports the simultaneous administration of RZV and aIIV4 among older adults. ClinicalTrials.gov Identifier: NCT05007041.

S1210 Lower Rates of Recurrent Herpes Zoster Complications in Patients With Inflammatory Bowel Disease Who Received Recombinant Zoster Vaccination: A Propensity Score Matched Analysis

S1210 Lower Rates of Recurrent Herpes Zoster Complications in Patients With Inflammatory Bowel Disease Who Received Recombinant Zoster Vaccination: A Propensity Score Matched Analysis

Recombinant Zoster Vaccination Among US Veterans Receiving Immunosuppressive Medications

Recombinant Zoster Vaccination Among US Veterans Receiving Immunosuppressive Medications