Tale of two vaccines: differences in response to herpes zoster vaccines

Abstract

About one-third of the US population will develop herpes zoster (HZ, commonly known as shingles) over a lifetime, while two-thirds will not. It is not clear exactly why certain people are susceptible to HZ; however, we may be coming closer to an answer. In this issue of the JCI, a study by Levin et al. provides important details concerning pathogenesis of and protection from HZ. The authors characterized differences in the immunologic responses induced by two HZ vaccines, the live attenuated zoster vaccine (ZV) and the more recently developed adjuvanted varicella-zoster virus (VZV) glycoprotein E (gE) subunit herpes zoster vaccine (HZ/su), in vaccine-naive subjects and those previously vaccinated with HZ. The observed differences in responses paralleled the observed clinical protection of the two zoster vaccines, with HZ/su being superior to HZ. Together, these results seem to explain immunologically why the new subunit vaccine outperforms the live vaccine. These differences may also provide clues as to why HZ develops in the first place.

Figure 1. Live attenuated and adjuvanted component vaccines for HZ elicit different responses.

Both vaccine-naive subjects and those that have received the live attenuated ZV vaccine more than 5 years ago exhibit a low baseline response to the VZV gE. Following immunization with ZV, subjects had a measurable increase in gE-specific T cell response and memory T cell (Tmem) response to gE and IL-12 at 1 month. In contrast, subjects that received the adjuvanted component vaccine HZ/su had a marked increase in gE-specific T cell response and memory T cell response to gE and IL-12 at 1 month after vaccination. One year after vaccination, T cell responses were minimal in subjects that received ZV; however, these responses were sustained in patients that received HZ/su.