Recommendations for immunization with recombinant herpes zoster vaccine in patients with autoimmune chronic inflammatory rheumatic diseases

Abstract

In January-February 2022, the latest consensus on vaccine recommendations in adults withautoimmune chronic inflammatory rheumatic diseases (ACIRD) was published, carried outjointly with experts from the Argentine Society of Rheumatology and the Argentine Societyof Infectious Diseases (SAR/SADI). As an addendum to the same, we make recommendationsfor immunization with the recombinant herpes zoster vaccine (RHZV) in the population of patients with ERICA.In the last year in Argentina, the vaccine for the varicella zoster virus was approved, an inactivated subunit vaccine, a recombinant that contains the glycoprotein E of the varicella zoster virus together with the AS0I adjuvant system. It demonstrated high efficacy and safety in the immunocompetent population, as well as in immunocompromised patient populations. For this reason, together with a group of expert infectologists, wedeveloped recommendations for the use of this vaccine in the population of patients with ACIRD.This document is divided into two parts. The first contains vaccination recommendations in different scenarios of common presentation in daily practice. A bibliographic review and a consensus of experts was carried out for the points that had less evidence. Thesecond part consists of six recommendations developed through the GRADE methodology.The evidence was analyzed in the population of patients with ACIRD, with or without immunosuppressive treatment, observing an acceptable response to the RHZV vaccine, both humoral and cellular, and proving to be safe in this patient population. On the other hand, high efficacy/effectiveness was proven in preventing episodes of herpes zoster and postherpetic neuralgia, as well as greater efficacy/effectiveness than the attenuatedvirus vaccine.In conclusion, based on the available evidence, this panel of experts recommends the RHZV vaccine in patients with ACIRD, regardless of whether they have previously received the live attenuated virus vaccine, since it is safe, effective and, for the moment, was also not associated with reactivation/outbreak of the underlying disease.with reactivation/outbreak of the underlying disease.