Session Time: 3:15pm-4:45pm
Presentation Time: 3:27pm-3:39pm
*Purpose: The new adjuvanted subunit recombinant herpes zoster vaccine (RZV; Shingrix™) may have potential utility in transplant patients for the prevention of shingles, but there are limited data on its immunogenicity in this population. We conducted a prospective study to evaluate RZV immunogenicity in lung transplant recipients (LTR) who are known to be at high risk for herpes zoster reactivation compared to other organ transplant recipients.
*Methods: We enrolled adult LTR ≥ 50 years of age and administered two doses of RZV at 0,2-6 months. VZV anti-glycoprotein E (gE) antibody concentrations, gE antibody avidity, and gE-specific polyfunctional CD4 T-cells (CD4 T-cells expressing at least 2 out of 4 activation markers assessed) were measured at baseline, after the first vaccine dose and 4-weeks after the second vaccine dose.
*Results: Of 50 enrolled LTRs, 49 received at least one vaccine dose. The median time from transplant was 3.0 years (IQR 1.0-5.0) and 24.5% of patients received the vaccine within the first year post-transplant. The gE-antibody concentration increased significantly from baseline to post-dose 1 (median optical density (OD) 1.96, IQR 1.17-2.89 vs. 3.41, IQR 2.54-3.81, p<0.001) and increased further after the second dose (median OD 3.63, IQR 3.39-3.86, p<0.001; Figure 1A). Vaccination also increased the avidity of gE specific antibodies (Figure 1B). The number of gE-specific polyfunctional CD4+ T-cells significantly expanded after each vaccine dose (median [IQR] at baseline was 85 CD4+ cells/106 [46-180] vs. post-dose 1: 128 [82-353]; vs. post-dose 2: 361 [146-848]; Figure 1C). LTRs who were vaccinated later after transplantation had higher polyfunctional gE-specific CD4 cell counts at baseline (p=0.010) and a trend towards higher cell counts after the second vaccine (p=0.051). The most common local adverse event was pain (83.0%) and redness (31.9%). General symptoms such as transient myalgia (36.2%), fatigue (31.9%) or headache (23.4%) were also common. Three patients had a rejection episode within three months after the last vaccine dose and two patients developed shingles shortly after the first vaccine dose.
*Conclusions: We provide unique data for RZV in LTRs that demonstrates the ability to generate both humoral and cellular immune responses. Local and systemic reactogenicity events were common but self-limited. RZV can be considered an option for the prevention of shingles in lung transplant recipients.
To cite this abstract in AMA style:Hirzel C, Ferreira VH, L’Huillier AG, Ku T, Ierullo M, Miao C, Schmid DS, Tikkanen J, Singer LG, Humar A, Kumar D. Safety and Immunogenicity of Adjuvanted Recombinant Subunit Herpes Zoster Vaccine in Lung Transplant Recipients
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