Immunogenicity of Recombinant Zoster Vaccine: A Systematic Review, Meta-Analysis, and Meta-Regression

Author:

Losa Lorenzo1ORCID,Antonazzo Ippazio Cosimo12ORCID,Di Martino Giuseppe34ORCID,Mazzaglia Giampiero1ORCID,Tafuri Silvio5ORCID,Mantovani Lorenzo Giovanni12,Ferrara Pietro12ORCID

Affiliation:

1. Center for Public Health Research, University of Milan–Bicocca, 20900 Monza, Italy

2. Laboratory of Public Health, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy

3. Department of Medicine and Ageing Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy

4. Unit of Hygiene, Epidemiology and Public Health, Local Health Authority of Pescara, 65100 Pescara, Italy

5. Interdisciplinary Department of Medicine, Aldo Moro University of Bari, 70121 Bari, Italy

Abstract

Background: The adjuvanted recombinant zoster vaccine (RZV), consisting of varicella-zoster virus glycoprotein E (gE) and the AS01B adjuvant system, effectively prevents herpes zoster (HZ). In the absence of a well-defined correlate of protection, it is important to monitor the RZV immune response, as a proxy of clinical effectiveness. Methods: This systematic review examined post-vaccination parameters: humoral and cell-mediated immunity, avidity index, geometric mean concentration of antibody (GMC), and immunity persistence. The meta-analysis used a random-effects model, and subgroup and meta-regression analyses were conducted. Results: Among 37 included articles, after one month from RZV-dose 2, the pooled response rate for anti-gE humoral immunity was 95.2% (95%CI 91.9–97.2), dropping to 77.6% (95%CI 64.7–86.8) during immunosuppression. The anti-gE cell-mediated immunity-specific response reached 84.6% (95%CI 75.2–90.9). Varying factors, such as age, sex, coadministration with other vaccines, prior HZ, or live-attenuated zoster vaccine, did not significantly affect response rates. RZV induced a substantial increase in gE avidity. Immunity persistence was confirmed, with more rapid waning in the very elderly. Conclusions: This systematic review indicates that RZV elicits robust immunogenicity and overcomes immunocompromising conditions. The findings underscore the need for further research, particularly on long-term immunity, and have the potential to support HZ vaccination policies and programs.

Publisher

MDPI AG

Reference80 articles.

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3. (2024, May 05). Centers for Disease Control and Prevention—National Center for Immunization and Respiratory Diseases, Division of Viral Diseases. Shingles (Herpes Zoster), Available online: https://www.cdc.gov/shingles/hcp/clinical-overview.html.

4. What Does Epidemiology Tell Us about Risk Factors for Herpes Zoster?;Thomas;Lancet Infect. Dis.,2004

5. Immune Responses to the Adjuvanted Recombinant Zoster Vaccine in Immunocompromised Adults: A Comprehensive Overview;Dagnew;Hum. Vaccines Immunother.,2021

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