Safety and Immunogenicity of Co-Administration of Herpes Zoster Vaccines with Other Vaccines in Adults: A Systematic Review and Meta-Analysis.

ingentiumby ingentium

In Vaccines Literature.

Publication date: Jun 12, 2025

Introduction: Herpes zoster (HZ), or shingles, is a vaccine-preventable disease with two approved vaccines: the live-attenuated vaccine (LZV) and the adjuvanted recombinant zoster vaccine (RZV). Evidence on the immunogenicity and adverse events (AEs) following co-administration with other vaccines in adults is limited. This systematic review and meta-analysis aims to evaluate the immunogenicity and safety of HZ vaccines when co-administered with other vaccines. Methods: We followed PRISMA 2020 guidelines and systematically searched multiple databases (January 1950 to February 2024) for studies on HZ vaccination with concomitant vaccines in adults (≥18 years). Observational studies, randomized controlled trials (RCTs), and non-randomized controlled trials were included, excluding reviews, case series, case reports, editorials, and non-English publications. Risk of bias was assessed using Cochrane tools (RoB 2 and ROBINS-I). A meta-analysis compared geometric mean concentration (GMC) ratios and vaccine response rates (VRRs) for RZV, applying the Hartung-Knapp adjustment. For LZV, meta-analysis was not feasible, and results were described narratively. AEs were analyzed using risk ratios and presented in forest plots. Results: Out of 369 search hits, ten RCTs were included. In six RCTs, RZV was co-administered with influenza, COVID-19, pneumococcal vaccines (PCV13, PPSV23), or Tdap. The pooled GMC mean difference was -0. 04 (95% CI: -0. 10 to 0. 02, p = 0. 19), and the pooled VRR was 1. 00 (95% CI: 0. 99 to 1. 01, p = 0. 59). Local and systemic AEs showed pooled relative risks of 0. 99 (95% CI: 0. 95 to 1. 03, p = 0. 73) and 1. 01 (95% CI: 0. 91 to 1. 11, p = 0. 90), respectively. LZV co-administration was investigated in four RCTs and was safe; however, co-administration with PPSV23 resulted in reduced immunogenicity. Conclusions: The co-administration of RZV with other vaccines was safe and immunogenic. However, limited evidence suggests that co-administration of LZV with PPSV23 reduced the immunogenicity of LZV through an unknown mechanism. Still, RZV co-administration could enhance vaccine uptake in vulnerable populations.

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Concepts Keywords
Databases co-administration
February herpes zoster
Robins immune response
Vaccines safety
systematic review
vaccination

Semantics

Type Source Name
disease MESH Herpes Zoster
disease MESH vaccine-preventable disease
drug DRUGBANK Pentaerythritol tetranitrate
disease MESH influenza
disease MESH COVID-19
disease MESH Infectious Diseases
disease IDO bacteria
drug DRUGBANK Coenzyme M
disease IDO immune response
disease MESH infection
disease MESH varicella
disease IDO primary infection
disease MESH complications
disease MESH neuralgia
disease MESH death
disease IDO immunosuppression
disease IDO intervention
disease IDO process
disease MESH Hepatitis
disease MESH Diphtheria
drug DRUGBANK Yellow Fever Vaccine
drug DRUGBANK BCG vaccine
disease MESH tetanus
disease MESH pertussis
pathway KEGG Pertussis
drug DRUGBANK Tropicamide
disease IDO country
disease MESH dementia
disease MESH contraindications
disease MESH chronic conditions
disease MESH syndrome
disease IDO history
disease MESH hypersensitivity
disease MESH abnormalities
disease MESH pneumococcal infection
disease MESH cerebrospinal fluid leaks
disease MESH chronic renal failure
disease MESH nephrotic syndrome
disease MESH diabetes mellitus
disease IDO blood
disease IDO cell
disease IDO assay
disease IDO site
disease IDO replication
disease MESH clinical importance
disease MESH uncertainty
pathway REACTOME Innate Immune System
drug DRUGBANK Guanosine
disease MESH Coad
disease MESH Varicella Zoster Virus Infection

Original Article

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