Herpes zoster (HZ) is increasingly common in the aging and is experienced by approximately one in three people in their lifetime. It is also relatively common in immune-compromised people. Acute HZ causes severe pain, reduced quality of life and severe complications, including prolonged pain, or postherpetic neuralgia (PHN), and ocular zoster, which may rarely progress to blindness. In severely immune-compromised people disseminated zoster may affect the brain and liver. A second-generation vaccine, the Recombinant Zoster Vaccine, consisting of recombinant viral glycoprotein E and the Adjuvant System 01 (AS01B), now offers >90% efficacy against HZ and associated complications in immune-competent people. Efficacy persists above 80% for 11 years. In severely immune-compromised patients, the vaccine is safe with efficacy and/or immunogenicity of 68-87%. There is also excellent immunogenicity for those on JAK inhibitors and corticosteroid therapy. The vaccine offers a paradigm for successful and durable immunization in the aging and immune-compromised.
Keywords: Herpes zoster; adjuvant; aging; immune-compromised; protein vaccine; recombinant zoster vaccine; vaccine durability; vaccine efficacy; vaccine reactogenicity.