Prevention strategies against varicella zoster infection include chemoprophylaxis with acyclovir and live attenuated zoster vaccine. However, resistance to acyclovir has been problematic, and safety concerns have limited the use of the live attenuated vaccine in immunosuppressed patients. Recombinant zoster vaccine, made available in 2017 for the immunocompetent host, has been evaluated for safety, immunogenicity, and efficacy in several immunocompromised settings as well. The present review compares the live attenuated vaccine and the recombinant zoster vaccine and highlights data on the use of recombinant zoster vaccine in different immunocompromised states. Robust data are available for the safety, immunogenicity, and efficacy of the recombinant vaccine in the autologous stem cell population, particularly among patients with multiple myeloma. The vaccine appears safe and immunogenic in populations including those with cancer (solid tumors and hematologic malignancies), HIV-infected patients, and renal transplant recipients. Efficacy and safety data in other populations are awaited before use of the recombinant vaccine can be more widespread. It is anticipated that an increased use of the recombinant zoster vaccine, particularly in immunosuppressed patients, would lead to a decreased use of acyclovir prophylaxis.
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