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New inactivated recombinant zoster vaccine use in the setting of common variable immunodeficiency

Question:

3/27/2019
In patients with CVID on IgG replacement, is there any guidance on giving Shingrix, the new zoster vaccine? The previous vaccine Zostavax was contraindicated as it is a live vaccine, but I cannot find any information regarding the new recombinant vaccine.

Answer:

The CDC website notes the following general information:

Q: Can Shingrix be administered to immunocompromised individuals?

A: While Shingrix is not contraindicated in immunocompromised persons, it is not recommended by ACIP at this time. ACIP will begin reviewing evidence for Shingrix in immunocompromised people as soon as it becomes available and will modify vaccine policy as necessary. You can still give Shingrix to someone who is taking low-dose immunosuppressive medication, anticipating immunosuppression, or has recovered from an immunocompromising illness.

Human immunoglobulin replacement materials have some anti-Herpes zoster antibody.

Since a significant effect of the new Herpes zoster vaccine, which is an inactivated recombinant adjuvanted vaccine, is on T-cell immunity, which is not generally seriously compromised in individuals with common variable immunodeficiency, I would recommend giving it.

I hope this information is of help to you and your patient.

Regards,
Eric Macy, MD, MS, FAAAAI