Review

Preventing herpes zoster in immunocompromised patients: Current concepts

Cassandra Calabrese, DO, Elizabeth Kirchner, DNP, James Fernandez, MD, PhD and Leonard H. Calabrese, DO
Cleveland Clinic Journal of Medicine July 2024, 91 (7) 437-445; DOI: https://doi.org/10.3949/ccjm.91a.24019

ABSTRACT

Herpes zoster (HZ) incidence is much higher in immunocompromised individuals than in immunocompetent individuals. HZ also occurs at a younger age and is often more severe in immunocompromised persons. Preventive strategies center around the recombinant zoster vaccine (RZV), which is approved for immunocompromised adults age 19 and older. Identifying those at greatest risk is critical. For those considering vaccination, evidence gaps regarding vaccine efficacy, toxicity, length of protection, and potential effects on underlying conditions may complicate shared and informed decision-making. Recent data have filled some of these gaps, with several societies issuing recommendations regarding vaccination. Remaining gaps are currently addressed by expert opinion.

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  1. 18982-cassandra-calabreseCassandra Calabrese, DO
  1. Department of Rheumatologic and Immunologic Disease, Cleveland Clinic, Cleveland, OH; Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
  1. 5939-elizabeth-kirchnerElizabeth Kirchner, DNP
  1. Department of Rheumatologic and Immunologic Disease, Cleveland Clinic, Cleveland, OH
  1. 17200-james-fernandezJames Fernandez, MD, PhD
  1. Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, OH; Clinical Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
  1. 337-leonard-calabreseLeonard H. Calabrese, DO⇑
  1. Department of Rheumatologic and Immunologic Disease, Cleveland Clinic, Cleveland, OH; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
  1. Address:
    Leonard H. Calabrese, DO, Department of Rheumatologic and Immunologic Disease, A50, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH; calabrl{at}ccf.org

ABSTRACT

Herpes zoster (HZ) incidence is much higher in immunocompromised individuals than in immunocompetent individuals. HZ also occurs at a younger age and is often more severe in immunocompromised persons. Preventive strategies center around the recombinant zoster vaccine (RZV), which is approved for immunocompromised adults age 19 and older. Identifying those at greatest risk is critical. For those considering vaccination, evidence gaps regarding vaccine efficacy, toxicity, length of protection, and potential effects on underlying conditions may complicate shared and informed decision-making. Recent data have filled some of these gaps, with several societies issuing recommendations regarding vaccination. Remaining gaps are currently addressed by expert opinion.

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