Adjuvanted recombinant zoster vaccine is effective against herpes zoster ophthalmicus, and is associated with lower risk of acute myocardial infarction and stroke in adults aged ≥50 years

Abstract Background Herpes zoster (HZ) and HZ ophthalmicus (HZO) are associated with an increased risk of cardiovascular complications, such as acute myocardial infarction (AMI) and stroke. We evaluated the association between recombinant zoster vaccine (RZV) and risk of HZO, hospitalized AMI, and hospitalized stroke in adults ≥50 years of age (YoA) at Kaiser Permanente Southern California. Methods We conducted a matched cohort analysis of adults ≥50 YoA who received 2 doses of RZV 4 weeks–6 months apart during 01 April 2018–31 December 2020 and were matched 1:4 to RZV-unvaccinated individuals on age, sex, race/ethnicity, and index date (date of second dose among vaccinated; unvaccinated match assigned same date). Follow-up started at index date and ended at receipt of zoster vaccine, termination of membership, death, or 12/31/2022, whichever came first. HZO was identified by natural language processing of clinical notes; hospitalized AMI and stroke were identified by ICD-10 codes. Stratified Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI). Results Among 102,766 2-dose RZV-vaccinated and 411,064 unvaccinated adults, 59.0% were female, 57.1% non-Hispanic White, and median age was 68 years (range: 50, 108). The aHRs (95% CI) of HZO, hospitalized AMI, and hospitalized stroke comparing RZV-vaccinated and unvaccinated individuals were 0.271 (95% CI: 0.222, 0.330), 0.720 (0.588, 0.881), and 0.575 (0.533, 0.619), respectively. The adjusted RZV effectiveness against HZO was 72.9% (67.0%, 77.8%). Conclusions Among adults ≥50 YoA, 2 RZV doses were associated with a lower risk of HZO, AMI, and stroke.