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

Special Populations*****

Persons With a History of Herpes Zoster

Herpes zoster can recur. Persons with a history of herpes zoster should receive RZV.

Persons With no Documented History of Varicella, Varicella Vaccination, or Herpes Zoster

Persons who have neither experienced varicella nor received varicella vaccine are not at risk for herpes zoster. More than 99% of Americans born before 1980 have had varicella.[21] Children and adolescents who have received live-attenuated varicella vaccines are at lower risk for herpes zoster than are those who experienced varicella.[22,23] RZV is not indicated and has not been studied for the prevention of varicella. For immunocompromised persons, evidence of immunity to varicella (confirming need for RZV) includes documented receipt of 2 doses of varicella vaccine, laboratory evidence of immunity or laboratory confirmation of disease, or diagnosis or verification of a history of varicella or herpes zoster by a health care provider. For immunocompromised adults with no documented history of varicella, varicella vaccination, or herpes zoster, providers should refer to the ACIP varicella vaccine recommendations for further guidance, including postexposure prophylaxis guidance.[24]


There is currently no ACIP recommendation for RZV use in pregnancy; therefore, providers should consider delaying RZV until after pregnancy. There is no recommendation for pregnancy testing before vaccination.


Recombinant vaccines such as RZV pose no known risk to mothers who are breastfeeding or to their infants.[17] Clinicians may consider vaccination without regard to breastfeeding status if RZV is otherwise indicated.