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1. In this randomized controlled trial, autologous hematopoietic stem cell transplant recipients who received 2 doses of recombinant herpes zoster vaccine had a reduced incidence of herpes zoster compared with placebo.
2. Injection site pain, myalgia, and fatigue were the most common adverse reactions to the vaccine.
Level of Evidence: Level 1 (Excellent)
Summary of the study: After an autologous hematopoietic stem cell transplant (HSCT), there is a risk of shingles as a result of a decrease in T cell immunity during the first two to three years. Vaccination may provide long-term protection against shingles, but the vaccine can not be directly attenuated as it is contraindicated in immunocompromised patients. In this randomized controlled trial, HSCT patients who received 2 doses of non-living recombinant zoster vaccine shortly after autologous HSCT had a reduced incidence of herpes zoster after a median follow-up of nearly 2 years compared with placebo. Injection site pain, myalgia, and fatigue were the most common adverse reactions to the vaccine.
Although this represents a promising prophylactic treatment for these patients, this study has several limitations. There was not enough power to compare the incidence of herpes zoster-related complications, excluding post-herpetic neuralgia, post-herpetic neuralgia and hospitalizations. In addition, the study was not long enough to badess effects beyond the second year.
Click to read the study in JAMA
Relevant reading: Herpes zoster after autologous hematopoietic stem cell transplantation without antiviral prophylaxis.
In depth [randomized controlled trial]: The study on the efficacy of shingles in patients undergoing an HSCT trial (ZOE-HSCT) recruited 1846 patients who underwent autologous HSCT. Patients were randomized to receive 2 doses of vaccine or placebo. The median follow-up of 21 months began one month after dose 2. 184 cases of confirmed shingles occurred in the modified total vaccine cohort (49 vaccine recipients and 135 placebo recipients). The overall incidence of herpes zoster was 30 and 94 per 1000 person-years in the vaccine and placebo groups, respectively, and the rate of incidence rate (IRR) of the first herpes zoster episode was 0.32 (CI ).95 0.22 to 0.44). With respect to secondary outcomes, the number of participants with herpes zoster complications was low. Solicited injection site reactions and systemic symptoms occurring within 7 days of vaccination were more common in vaccine recipients (90%) than in placebo recipients (53%). Pain was the most common symptom at the injection site, occurring in 84% of the vaccinees.
Picture: PD
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