Ann Intern Med

Recombinant zoster vaccine effective in older adults, regardless of immunocompetence or prior live vaccine

October 20, 2025

Study details: This target trial emulation using a 20% random sample of U.S. Medicare beneficiaries (age ≥65) from 2018–2019 assessed recombinant zoster vaccine (RZV) effectiveness, accounting for immunocompetence and prior live zoster vaccine (ZVL) receipt. Participants received one or two RZV doses, with outcomes including herpes zoster (HZ), HZ ophthalmicus, and postherpetic neuralgia.

Results: RZV was 56.1% effective (95% confidence interval [CI], 53.1–59.0%) against any HZ outcome, with similar protection in immunocompetent (56.5%) and immunocompromised (54.2%) individuals. Prior ZVL recipients benefited from RZV. Completing the two-dose series conferred an additional 67.9% effectiveness compared with one dose. Adverse events weren't increased in immunocompromised patients.

Clinical impact: RZV is effective in older adults, including those immunocompromised or previously vaccinated with ZVL, and two doses are superior to one.

Source:

Vielot NA, et al. (2025, October 14). Ann Intern Med. Effectiveness of Recombinant Herpes Zoster Vaccine in the U.S. Medicare Population, 2018 to 2019, by Immunocompetence and Prior Receipt of Live Zoster Vaccine. https://pubmed.ncbi.nlm.nih.gov/41082726/