Use of Recombinant Zoster Vaccine in Immunocompromised Adults Aged ≥19 Years

Recommendations of the Advisory Committee on Immunization Practices--United States, 2022

Tara C. Anderson, DVM, PhD; Nina B. Masters, PhD; Angela Guo, MPH, MBA; Leah Shepersky, MPH; Andrew J. Leidner, PhD; Grace M. Lee, MD; Camille N. Kotton, MD; Kathleen L. Dooling, MD


Morbidity and Mortality Weekly Report. 2022;71(3):80-84. 

In This Article

Clinical Guidance§§§§

Dosing Schedule

Two RZV doses are necessary, regardless of previous history of herpes zoster or previous receipt of zoster vaccine live. The second RZV dose should typically be given 2–6 months after the first; for persons who are or will be immunodeficient or immunosuppressed and who would benefit from a shorter vaccination schedule, the second dose can be administered 1–2 months after the first.[2] If the second RZV dose is given sooner than 4 weeks after the first, a valid second dose should be repeated at least 4 weeks after the dose given too early. The vaccine series does not need to be restarted if more than 6 months have elapsed since the first dose.

Timing of Vaccination

When possible, patients should be vaccinated before becoming immunosuppressed. Otherwise, providers should consider timing vaccination when the immune response is likely to be most robust (i.e., during periods of lower immunosuppression and stable disease). RZV may be administered to patients who previously received varicella vaccine. RZV is not a live virus vaccine; therefore, RZV may be administered while patients are taking antiviral medications.

Coadministration With Other Vaccines

Recombinant and adjuvanted vaccines, such as RZV, can be administered concomitantly, at different anatomic sites, with other adult vaccines, including COVID-19 vaccines.[17] Concomitant administration of RZV with other adult vaccines¶¶¶¶ has been studied, and there was no evidence for interference in the immune response to either vaccine or of safety concerns.[18–20] Coadministration of RZV with adjuvanted influenza vaccine (Fluad) and COVID-19 vaccines is being studied.

Counseling for Reactogenicity

Before vaccination, providers should counsel patients about expected local and systemic reactogenicity, including grade 3 reactions. It is generally not recommended to take antipyretic or analgesic medications prophylactically before vaccination; however, antipyretic or analgesic medications may be taken for the treatment of postvaccination local or systemic symptoms. Patients should be encouraged to complete the series even if they experienced a (nonanaphylactic) grade 1–3 reaction after receipt of the first RZV dose.

¶¶¶¶Fluarix Quadrivalent (influenza vaccine), 23-valent pneumococcal polysaccharide vaccine (PPSV23, Pneumovax23), tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap, Boostrix).