ACIP Recommends Shingrix for Younger Immunocompromised Adults; Updates Pneumococcal Vaccine Guidance

Lucy Hicks

October 21, 2021

The US Centers for Disease Control and Prevention Advisory Committee of Immunization Practices (ACIP) has voted to recommend Shingrix (Zoster Vaccine Recombinant, Adjuvanted) for the prevention of shingles (herpes zoster) in immunodeficient or immunosuppressed adults aged 19 or older. The recommendation was approved October 20 by a unanimous vote.

Shingles is a reactivation of varicella zoster virus (VZV), the virus that causes chickenpox. There are about 1 million cases of shingles in the US every year, according to CDC estimates, and 1 in 3 Americans will develop shingles over their lifetime. While adults older than 50 are one of the most vulnerable groups to reinfection — with about 99% having been infected with VZV — a weakened immune system is another common risk factor.

The FDA originally approved Shingrix in 2017 for the prevention of shingles in adults over 50; in July of this year, the vaccine was approved for immunodeficient adults aged 18 or older. The approval and subsequent recommendation by the ACIP were based on clinical studies of Shingrix in adults being treated for hematologic malignancies or those who had undergone an autologous hematopoietic stem cell transplant.

According to a press statement from the FDA, "Further safety and immunogenicity data were generated in adults who were, or were anticipated to be, immunodeficient or immunosuppressed due to known disease or therapy, including patients with HIV, solid tumors, and renal transplants."

For adults with functional immune systems, Shingrix is administered in two doses, 2 to 6 months apart. For immunocompromised individuals, the second dose can be given 1 to 2 months after the first dose.

During the same meeting, the ACIP also voted to recommend pneumococcal vaccines for routine use in adults older than 65 and in adults aged 19-64 with chronic conditions such as diabetes, chronic heart disease, chronic liver disease, and HIV, and disease risk factors like smoking and alcoholism. The recommendation only applies to those who have not received a pneumococcal conjugate vaccine or whose vaccination history is unknown. The recommendation states that qualifying adults should be vaccinated with the 15-valent pneumococcal conjugate vaccine Vaxneuvance followed by PNEUMOVAX23, or a single dose of the 20-valent pneumococcal conjugate vaccine Prevnar 20.

These ACIP recommendations will now be sent to the directors of the CDC and the US Department of Health and Human Services for review and approval. If approved, the recommendations are considered finalized and will be published in a future Morbidity and Mortality Weekly Report.

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