Wessely Andrea, Zwazl Ines, Poturica Melita, Weseslindtner Lukas, Kundi Michael, Wiedermann Ursula, Wagner Angelika
Center for Pathophysiology, Infectiology and Immunology, Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, 1090 Wien, Austria.
Center for Virology, Medical University of Vienna, 1090 Wien, Austria.
Vaccines (Basel). 2025 Jul 8;13(7):737. doi: 10.3390/vaccines13070737.
Immunocompromised patients are at risk of severe varicella zoster virus (VZV) infection and reactivation. In VZV seronegative immunocompromised persons, live-attenuated VZV vaccination is contraindicated, thus the recombinant herpes zoster vaccine (rHZV) remains a safe alternative, although an off-label application. Yet, data on the induction of a VZV-specific immune response in immunocompromised individuals with VZV-specific IgG below the assay's cut-off are only available for patients after solid-organ transplantation (SOT). : We retrospectively analyzed the induction of VZV-specific IgG antibody levels after vaccination with rHZV in immunocompromised patients who previously tested anti-VZV-IgG negative between March 2018 and January 2024. : Of 952 vaccinees screened that received 2 or 3 doses rHZV, depending on the underlying disease, 33 patients (median age 53.0; 51.5% female) with either hematopoietic stem cell transplantation (82%) or high-grade immunosuppressive treatment (18%) fulfilled the inclusion criteria. Upon rHZV vaccination, 88% (29/33) individuals mounted a significant antibody response exceeding the assay's cut-off level for seropositivity ( < 0.0001). We detected higher geometric mean antibody concentrations after three compared to two doses. However, 12% remained below the assay's cut-off level and were therefore considered non-responsive. : The rHZV is immunogenic in VZV-seronegative immunocompromised individuals and therefore presents a valid option to induce seroconversion. However, antibody testing in high-risk groups should be considered to identify humoral non- and low responders.
免疫功能低下的患者有发生严重水痘带状疱疹病毒（VZV）感染和再激活的风险。在VZV血清学阴性的免疫功能低下者中，禁忌接种减毒活VZV疫苗，因此重组带状疱疹疫苗（rHZV）仍是一种安全的替代选择，尽管属于超说明书用药。然而，关于VZV特异性IgG低于检测下限的免疫功能低下个体接种疫苗后诱导VZV特异性免疫反应的数据仅来自实体器官移植（SOT）后的患者。我们回顾性分析了2018年3月至2024年1月期间既往抗VZV-IgG检测为阴性的免疫功能低下患者接种rHZV后VZV特异性IgG抗体水平的诱导情况。在952名根据基础疾病接种2剂或3剂rHZV的受种者中，33例患者（中位年龄53.0岁；51.5%为女性）符合纳入标准，其中82%为造血干细胞移植患者，18%为接受高强度免疫抑制治疗的患者。接种rHZV后，88%（29/33）的个体产生了显著的抗体反应，超过了血清学阳性的检测下限（<0.0001）。与接种两剂相比，接种三剂后检测到更高的几何平均抗体浓度。然而，12%的个体仍低于检测下限，因此被认为无反应。rHZV在VZV血清学阴性的免疫功能低下个体中具有免疫原性，因此是诱导血清转化的有效选择。然而，应考虑在高危人群中进行抗体检测，以识别体液无反应者和低反应者。
