Article Impact Level: HIGH Data Quality: STRONG Summary of Annals of Internal Medicine https://doi.org/10.7326/ANNALS-24-02409 Dr. Nadja A. Vielot et al.
Points
- The recombinant zoster vaccine (RZV), recommended since 2018, was evaluated for effectiveness against herpes zoster outcomes in a random sample of Medicare beneficiaries aged 65 years or older.
- Overall vaccine effectiveness (VE) against any herpes zoster outcome was 56.1%, calculated across 12 sequential target trials using weighted Fine and Gray models on real-world vaccination data.
- VE was nearly identical between groups, with immunocompetent participants showing 56.5% effectiveness and immunocompromised participants showing 54.2% effectiveness, demonstrating robust protection.
- The analysis confirmed that individuals who had previously received the live zoster vaccine (ZVL) in the past ten years still benefited significantly from a subsequent RZV dose.
- A second RZV dose provided a substantial boost, conferring an additional 67.9% effectiveness against any herpes zoster outcome compared to just one RZV dose.
Summary
This study assessed the recombinant zoster vaccine (RZV) effectiveness (VE) in the U.S. Medicare population from 2018 to 2019 using target trial emulation, accounting for prior receipt of the live zoster vaccine (ZVL) and individual immunocompetence. Analysis 1 pooled data from 12 sequential trials of at least 12 months’ duration, utilizing weighted Fine and Gray models with robust variance estimation to estimate VE against outcomes of herpes zoster (HZ), HZ ophthalmicus, and postherpetic neuralgia in beneficiaries aged ≥65 years with continuous Part D coverage and no prior RZV/HZ claims since 2007.
The overall pooled VE against any HZ outcome was calculated to be 56.1% (95%CI,53.1% to 59.0%), demonstrating a robust protective effect. VE estimates were similar between subgroups, with immunocompetent individuals showing 56.5% (CI,53.2% to 59.5%) effectiveness and immunocompromised individuals showing 54.2% (CI,44.7% to 62.1%) effectiveness. Notably, individuals previously vaccinated with ZVL within the last 10 years were shown to benefit from RZV administration.
Analysis 2, which used the same methodology with 10 trials beginning 60 days from the first dose, revealed that a second RZV dose conferred an additional 67.9% effectiveness against any HZ outcome when compared to a single dose. These results strongly support the preferential recommendation of RZV over ZVL, confirming its substantial and comparable effectiveness across both immunocompetent and immunocompromised older adults in the Medicare population.
Link to the article: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02409
References
Vielot, N. A., Jonsson Funk, M., Stürmer, T., Fix, J., Becker-Dreps, S., Weber, D. J., & Lund, J. L. (2025). Effectiveness of recombinant herpes zoster vaccine in the u. S. Medicare population, 2018 to 2019, by immunocompetence and prior receipt of live zoster vaccine. Annals of Internal Medicine, ANNALS-24-02409. https://doi.org/10.7326/ANNALS-24-02409
