Zoster Vaccine in Immunocompromised Patients: Time to Reconsider Current Recommendations

to varicella zoster virus (VZV) is asso-ciated with an increase in the risk and severity of herpes zoster (HZ) and its de-bilitating complications, including post-herpetic neuralgia (PHN). This is true whether the reduction in VZV CMI is due to the age-related decline in CMI observed in normal older adults, or to immunosuppression caused by certain diseases or their treatments. Zoster vac-cines containing the Oka strain of live at-tenuated VZV have proven to be safe and effective in older adults, but current recom-mendations preclude their use in immuno-compromised persons. In this issue of Clinical Infectious Diseases, Tseng et al [1] report that zoster vaccine, administered to adults ≥60 years of age, continued to protect against HZ when recipients subsequently underwent cancer chemo-therapy. These findings underline the im-portance of administering zoster vaccine to immunocompetent older adults as cur-rently recommended [2], and doing so as early as possible. In addition, the results of these and similar studies suggest that it may be time to review the current pol-icy of excluding all immunocompromised persons from receiving zoster vaccine. The study by Tseng et al [1] was con-ducted among members of Kaiser Perma-nente Southern California (KPSC), an integrated healthcare system that pro-vides prepaid comprehensive healthcare to its 3.6 million community-dwelling members, and tracks demographics, ser-vices, and diagnoses in KPSC electronic health records from outpatient, emergen-cy department, and hospital encounters. KPSC provides zoster vaccine to its mem-bers, as recommended [2], at no charge. The cohort studied consisted of KPSC members aged ≥60 years who received cancer chemotherapy with myelosup