Herpes Zoster Vaccination in Patients with Immune-Mediated Inflammatory Diseases: A Systematic Review and Meta-Analysis of Vaccine Efficacy, Effectiveness, and Safety.

BACKGROUND

Patients with immune-mediated inflammatory diseases (IMIDs) are at increased risk of herpes zoster (HZ) due to immune dysregulation and immunosuppressive therapy. This systematic review aimed to evaluate the vaccine efficacy/effectiveness (VE) and safety outcomes of the HZ vaccine in patients with IMIDs.

METHODS

PubMed, Cochrane Library, and Scopus were searched for clinical trials and cohort studies evaluating recombinant zoster vaccine (RZV) or zoster vaccine live (ZVL) in adults with IMIDs. Effect sizes were expressed as VE% and risk ratio (RR) with 95% confidence intervals (CIs). Random-effects meta-analyses used restricted maximum likelihood estimation.

RESULTS

Twenty-six studies involving 2,238,638 patients with various IMIDs were included. RZV efficacy was 90.5% (69.1%-97.1%), while effectiveness was 59.0% (49.8%-66.5%). ZVL effectiveness was 42.4% (37.1%-47.3%). RZV reduced post-herpetic neuralgia, with VE of 33.6% (11.7%-50.0%). Disease flares were not increased significantly in RZV (RR 1.05 [0.91-1.22]) and ZVL (RR 1.29 [0.69-2.43]). Reactogenicity and systemic adverse events were more frequent following HZ vaccination, particularly with RZV.

CONCLUSION

HZ vaccination, especially RZV, effectively prevents HZ in patients with IMIDs and is generally well tolerated. These findings support RZV use while emphasizing individualized assessment of vaccination timing and immunosuppressive treatment. Further studies should examine long-term effectiveness and safety across IMID subtypes and immunosuppressive regimens.