Study: Shingles Reactivation Could Occur in Rare Cases Following RZV

New study findings assessed the efficacy and safety of the recombinant zoster vaccine (Shingrix, RZV; GSK) compared with the zoster vaccine live (Zostavax; ZVL; Merck & Co., Inc.) to evaluate rare adverse events that could occur after receiving an immunization.¹

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The FDA approved ZVL in 2006 for the prevention of varicella zoster virus (VZV)—an infection known to cause chicken pox and can reactivate as shingles after the initial infection. VZV is known to remain dormant for many years, but when reactivated it travels along sensory nerve fibers, resulting in shingles infection. The virus results in development of painful, blistering rashes in a dermatomal distribution. Following, the FDA approved RZV in 2017 as an updated shingles vaccine due to displays of dissemination among immunocompromised individuals vaccinated with ZVL.²

According to the release, the CDC Advisory Committee on Immunization Practices released a recommendation for RZV, suggesting that it is the preferred vaccine to treat VZV compared to ZVL. Study authors noted that the recommendation was made based on clinical trials that displayed superior efficacy and safety of RZV compared to ZVL, with 90% efficacy against shingles across all age groups. The RZV vaccine is administered in 2 intramuscular doses and each dose requires a 2-to-6-month separation.²

“RZV uses a surface protein called glycoprotein E. It is combined with ASO1B, which is composed of two different lipids, monophosphoryl lipid A and saponin. This combination of ASO1B and gE generates a long-lasting immunological response, which has been shown to be more effective in reducing HZ in older patients than ZVL,” said the study authors in a news release.²

Despite RZVs positive results, the study authors noted that individuals can experience adverse events following the vaccination, although it is rare, noted study authors. Researchers assessed adverse events following RZV immunization in a 59-year-old White male that experienced paresthesia and a rash immediately following the vaccination.^1,2

The patient was treated in the hospital after reports of rash on the nasolacrimal area, forehead, and V1 dermatome, along with face tingling 9 days after receiving the RZV immunization. The release provided that prior to the hospital visit, the patient was treated with amoxicillin, valacyclovir, and eyedrops, but they did not ease the rash symptoms. The hospital prescribed him with mupirocin to alleviate further symptoms. He was tested for herpes simplex virus 1 and 2 which were negative, but he received a positive test for VZV, the study authors noted.²

In a 20-day follow-up with an ophthalmologist, the release provided that the V1 dermatome rash was resolved following the completion of a full dose of valacyclovir.²

The study authors noted that there have been various reports of patients experiencing dermatomal reactions similar to the highlighted patient. However, these adverse reactions were not displayed in previous clinical trials.^1,2

However, health care providers should continue to administer RVZ to patients with the knowledge that adverse reactions and reactivation could occur in rare cases.^1,2

“This underscores the need for constant monitoring and assessment of the RZV. Further studies are necessary to better understand how the immunomodulatory effects of RVZ may provoke reactivation of HZ,” said study authors in a news release.¹

REFERENCES

1. Herpes zoster ophthalmicus following recombinant zoster vaccine: A case report and brief literature review. National Library of Medicine. News release. August 28, 2024. Accessed September 20, 2024. https://pubmed.ncbi.nlm.nih.gov/39296531/

2. Herpes zoster ophthalmicus following recombinant zoster vaccine: A case report and brief literature review. Science Direct. News release. August 28, 2024. Accessed September 20, 2024. https://www.sciencedirect.com/science/article/pii/S221425092400146X?via%3Dihub.