Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr 19:53:127072.
doi: 10.1016/j.vaccine.2025.127072. Epub 2025 Apr 7.

Considering recombinant herpes zoster vaccine for fragile pediatric patients: A new opportunity

A Mollo  1 , M Peri  2 , L Lodi  3 , A Gissi  4 , P Lionetti  5 , E Marrani  6 , M V Mastrolia  7 , A Tondo  8 , V Tintori  9 , I Sardi  10 , G Indolfi  11 , S Trapani  12 , L Galli  13 , E Venturini  14 , V Astorino  15 , C Azzari  3 , S Ricci  3
Affiliations
Free article

Considering recombinant herpes zoster vaccine for fragile pediatric patients: A new opportunity

A Mollo et al. Vaccine. .
Free article

Abstract

Background: A recombinant vaccine is approved to prevent herpes zoster (HZ) in adults ≥50 years and immunocompromised individuals ≥19 years. However, in children, the live attenuated vaccine remains the only prevention strategy against varicella zoster virus (VZV), with only one trial evaluating the safety and immunogenicity of GlaxoSmithKline's HZ subunit candidate vaccine in immunocompromised children.

Objectives: To estimate VZV burden in our third level pediatric hospital and identify high-risk pediatric groups for its occurrence and complications to explore the need for an inactivated vaccine.

Methods: We reviewed VZV/HZ hospital discharge codes and positive VZV molecular tests at Meyer Children's Hospital from January 2018 to May 2023. We categorized patients based on their vaccination status as unvaccinated, partially vaccinated (single dose), or fully vaccinated (complete two-dose regimen). 96 controls from the same Departments and period were also included to assess VZV vaccine effectiveness.

Results: Of 48 patients with VZV (52 % female; median age: 11.6 years [IQR: 7-14.2]), 10 had chickenpox and 38 HZ; 2/48 (4.2 %) received 2 doses of vaccination, 10/48 (20.8 %) were immunized with 1 dose and 36/48 (75 %) were unvaccinated. Immune-related comorbidities were present in 20/48 (42 %) patients, and among those with HZ requiring hospitalization, comorbidities strongly predicted admission (OR 4.71; 95 % CI, 1.23-20.39; p = 0.028). Full vaccination was more frequent in controls (43/96, 45 %) than in cases (2/48, 4.2 %; p < 0.001).

Conclusions: In our cohort, many cases had comorbidities contraindicating the live attenuated vaccine. If proven safe and effective, the recombinant HZ vaccine could offer a preventive option for immunocompromised children ineligible for live viral vaccines.

Trial registration: ClinicalTrials.gov NCT04006808.

Keywords: Children; Herpes zoster; Immunocompromised; Recombinant herpes zoster vaccine; Varicella zoster virus.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Publication types

Associated data