#VisualAbstract: Effect of Recombinant Zoster Vaccine on Incidence of Herpes Zoster After Autologous Stem Cell Transplantation

1. In this randomized controlled trial, autologous hematopoietic stem cell transplantation patients who received 2 recombinant zoster vaccine doses had reduced incidence of herpes zoster compared to placebo.

2. Injection site pain, myalgia, and fatigue were the most common adverse reactions to the vaccine.

Evidence Rating Level: 1 (Excellent)

Study Rundown: After autologous hematopoietic stem cell transplantation (HSCT), there is risk of herpes zoster due to diminished T-cell immunity within the first 2 to 3 years. Vaccination can provide long-term protection against herpes zoster, but the vaccine cannot be live attenuated, as they are contraindicated in immunocompromised patients. In this randomized controlled trial, HSCT patients who received 2 doses of recombinant, non-live zoster vaccine shortly after autologous HSCT exhibited reduced incidence of herpes zoster after a median follow-up of close to 2 years compared to placebo. Injection site pain, myalgia, and fatigue were the most common adverse reactions to the vaccine.

While this represents a promising prophylactic treatment for these patients, this study has several limitations. There was not enough power to compare incidences of herpes zoster–related complications excluding post-herpetic neuralgia, post-herpetic neuralgia, and hospitalizations. Further, the study was not long enough to assess effects beyond the second year.

Click to read the study in JAMA