Ghesquière Wayne, Tessier Dominique, Brown Vivien, Guenther Lyn, Haaland Derek, Igoe John, MacDonald Kelly S, Whiskin Carolyn
Island Health Authority, Division of Infectious Diseases, Clinical Assistant Professor of Medicine, University of British Columbia, Victoria, BC, Canada.
Clinique d'infection virale chronique (CIVC), Hôpital Saint-Luc du CHUM in the Groupe de médecine de famille du Quartier Latin and Medical Director of the Groupe Santé Voyage in Montreal, Montreal, Canada.
Expert Rev Vaccines. 2025 Dec;24(1):769-781. doi: 10.1080/14760584.2025.2539884. Epub 2025 Aug 5.
Risk of herpes zoster (HZ) increases with age (notably at ≥50 years), with greater risk also apparent in immunocompromised populations. The use of the recombinant zoster vaccine (RZV) in adults aged ≥50 years is established in Canada. However, while licensed RZV use was expanded in 2021 to include individuals ≥18 years of age who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression caused by known disease or therapy, there remains some uncertainty for clinicians regarding which patients should be offered vaccination.
To assist decision-making, a Canadian multidisciplinary panel was convened to develop guidance on the use of RZV in at-risk adults aged ≥18 years through a consensus approach, defined as ≥75% of the experts rating their agreement.
The panel concluded that RZV should be offered to all at-risk individuals aged ≥18 years who are or will be at increased risk of HZ due to disease or therapy, in line with the licensed indication. This includes those with chronic medical conditions at greater risk of HZ (e.g. COPD, diabetes). Decisions should be individualized based upon patient assessment and shared clinical decision-making. Where possible, the two-dose vaccine series should be given at the earliest opportunity.
Findings from this expert consensus provide guidance on the use of RZV in individuals ≥18 years at increased risk of HZ. Our views complement updated national recommendations for immunocompromised patients issued in May 2025.
带状疱疹（HZ）的风险随年龄增长而增加（尤其是在≥50岁时），免疫功能低下人群的风险也更高。加拿大已确定在≥50岁的成年人中使用重组带状疱疹疫苗（RZV）。然而，尽管2021年RZV的许可使用范围扩大到包括因已知疾病或治疗导致免疫缺陷或免疫抑制而有或将会有更高HZ风险的≥18岁个体，但临床医生对于哪些患者应接种疫苗仍存在一些不确定性。
为协助决策，召集了一个加拿大多学科小组，通过一种共识方法制定关于在≥18岁的高危成年人中使用RZV的指南，该共识方法定义为≥75%的专家表示同意。
小组得出结论，应根据许可适应症，向所有因疾病或治疗而有或将会有更高HZ风险的≥18岁高危个体提供RZV。这包括患有HZ风险更高的慢性疾病的患者（如慢性阻塞性肺疾病、糖尿病）。决策应基于患者评估和共同的临床决策制定进行个体化。在可能的情况下，应尽早接种两剂疫苗系列。
这一专家共识的结果为在HZ风险增加的≥18岁个体中使用RZV提供了指导。我们的观点补充了2025年5月发布的针对免疫功能低下患者的最新国家建议。
