Summary of recommendations for recombinant zoster vaccine in immunocompromised groups
| Group (recommendation source) | Recommendations |
|---|---|
| Hematopoietic transplantation (CDC)23 | Autologous: wait at least 3 months after transplant Allogeneic: wait at least 6 months after transplant Initiate RZV about 2 months before discontinuation of antiviral therapya |
| Solid-organ transplantation (CDC)23 | Administer RZV prior to transplant (if possible) or 6–12 months after transplant when graft stable on maintenance immunosuppressiona |
| Malignancy (CDC)23 | Administer RZV before to treatment (if possible) or when the immune system is not acutely suppressed or is likely to be most robusta |
| Rheumatic inflammatory and musculoskeletal diseases (American College of Rheumatology)24 | Administering RZV is strongly recommended for patients with rheumatic and musculoskeletal diseases age > 18 who are taking immunosuppressive medication |
| Inflammatory bowel disease (American College of Rheumatology)24 | All patients receiving Janus kinase inhibitor therapy should receive RZV Risk of herpes zoster should be considered with combinations of other immunosuppressiveb therapies |
| Psoriasis (Medical Board of the National Psoriasis Foundation)25 | RZV should be given to all patients with psoriasis and psoriatic arthritis > age 50 and to patients < age 50 on tofacitinib, systemic corticosteroids, or combination systemic therapyb |
| Primary immunodeficiency diseases | No formal recommendations from societies as of now; per package insert RZV is indicated in adults age 18 and older who are or will be at increased risk of herpes zoster due to immunodeficiency or immunosuppression caused by known disease26 |
| HIV (CDC)27 | Patients with HIV ≥ age 18 should receive 2 doses of RZV at 0 and 2 to 6 months Consider delaying vaccination until the patient is virologically suppressed on antiretroviral therapy or until the CD4 count is > 200 cells/mm3 to ensure a robust vaccine response Patients with HIV ≥ age 18 should receive RZV regardless of previous history of herpes zoster or previous receipt of live zoster vaccine (no longer available) or therapy |
↵a Recommendations vary somewhat among societies; expert opinion was recently summarized.28
↵b Systemic immunosuppression refers to current treatment with prednisone (> 20 mg/day for more than 14 days), azathioprine (> 2.5 mg/kg/day), mercaptopurine (> 1.5 mg/kg/day), methotrexate (> 0.4 mg/kg/week), cyclosporine, tacrolimus, infliximab, adalimumab, golimumab, certolizumab, ustekinumab, or tofacitinib.
CDC = Centers for Disease Control and Prevention; HIV = human immunodeficiency virus; RZV = recombinant zoster vaccine