With pharmacists administering more and more of the vaccines received in the United States, they have to constantly update their information on effectiveness and potential adverse effects of various vaccines in subgroups.

An article in the Journal of Pharmacy Practice looked at current evidence on the efficacy and safety of human papillomavirus 9-valent (9vHPV), recombinant zoster (RZV), and CpG-adjuvanted recombinant hepatitis B (HepB-CpG) vaccines in adults with human immunodeficiency virus, inflammatory bowel disease, solid organ transplant, and allogeneic hematopoietic stem cell transplant.

Northeastern University–led authors point out, “Patients immunocompromised due to underlying disease or treatment are at increased risk for infections; however, insufficient understanding of various vaccines' efficacy, safety, indications, and contraindications in this population has led to suboptimal vaccination rates.”

The report notes that the Infectious Diseases Society of America has published guidelines on vaccines in immunocompromised populations in 2013, adding, “Since then, several advances have been made including an expanded indication with 9vHPV for use in males and females 9 to 45 years old, and the introduction of new vaccines for herpes zoster (RZV) and hepatitis B (HepB-CpG). 

Pharmacists are instrumental to vaccination efforts and may benefit from a review of recent vaccine updates.”

The review concludes that the 9vHPV may be used in men and women aged 9 to 45 years without regard to immune status, and HepB-CpG may be used in most immunocompromised patients yet remains underutilized.

The authors add that RZV safety and efficacy in several immunocompromised populations has been demonstrated but that recommendations have not always been updated. 

Another recent study in the journal Vaccine was based on a systematic literature review of recombinant subunit herpes zoster (HZ) vaccine use in immunocompromised adults aged 18 to 49 years. That is younger than the age group that routinely receives the vaccine.

Researchers from Laval University in Quebec point out that questions have been raised about the use of RZV in immunocompromised patients younger than age 50 years who are at increased risk for HZ.

For the review, four databases were searched and 1,389 potentially relevant records were found, with six studies fulfilling inclusion criteria. The most common adverse events were determined to be  pain at injection site (98.6%) and fatigue (75.3%.

“The proportion of patients reporting serious adverse events (SAEs) ranged between 8.1 and 30.8% in RZV and between 4.1 and 36.5% in placebo groups,” the researchers write. “SAEs deemed related to vaccination were reported in < 1% of patients in both RZV and placebo groups.”

In addition, the study reports that the proportion of patients who experienced clinically significant underlying disease-related events ranged from 0.0 to 20.0% in the RZV group and 0.0 to 26.7% in the placebo group. The authors add that the humoral and cell-mediated immune response rate ranged from 65.4% to 96.2% and 50.0% to 93.0%, respectively. 

“Vaccine efficacy in hematopoietic stem cell transplant patients was 72% (95%CI, 39-88%) in 18-49-year-olds and 67% (95%CI, 53-78%) in ≥ 50-year-olds (median follow-up 21 months). Vaccine efficacy in ≥ 18-year-old patients with hematologic malignancies was estimated at 87.2% (95%CI, 44.3-98.6%) up to 13 months post-vaccination,” the authors point out, adding, “Results suggest that RZV has an acceptable safety profile and induces immunity in an important proportion of ≥ 18-year-old immunocompromised patients. Longer follow-up studies are warranted to assess the duration of RZV induced immunity in immunocompromised patients.”
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