{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:08:38Z","timestamp":1790899718197,"version":"4.1.0"},"reference-count":58,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"unspecified","delay-in-days":47,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2026,5,3]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>Patients with inflammatory rheumatic diseases (IRDs) have a substantially increased risk of herpes zoster (HZ), driven by underlying immune dysregulation and immunosuppressive therapy, particularly high-dose glucocorticoids, biologic disease-modifying antirheumatic drugs and Janus kinase inhibitors. The adjuvanted recombinant zoster vaccine (RZV) has shown high efficacy in preventing HZ in older adults and durable protection for at least 10 years. Emerging data in immunocompromised populations, including rheumatology cohorts, support clinically meaningful protection with an acceptable safety profile.<\/jats:p>\n                  <jats:p>Recent evidence includes randomised controlled trials demonstrating non-inferiority of RZV vs placebo for short-term flare risk in adults with IRDs on stable immunosuppression. Real-world cohort data also showed a marked reduction in HZ relapse after vaccination (approximately 95%), with very few flares and no serious vaccine-related events. In contrast, a pharmacovigilance analysis of 920 autoimmune patients identified an 8.5% flare incidence and a threefold increased reporting OR for post-RZV flares, particularly in systemic lupus erythematosus, underscoring the need for short-term monitoring and clear counselling rather than avoidance of vaccination.<\/jats:p>\n                  <jats:p>Updated recommendations from the European Alliance of Associations for Rheumatology, the American College of Rheumatology, the Advisory Committee on Immunisation Practices\/Centers for Disease Control and Prevention and national bodies now support two doses of RZV for adults with IRD at increased HZ risk, including many receiving potent immunosuppression. This review summarises current evidence on the efficacy, effectiveness, durability and safety of RZV in IRD and interprets new data on vaccination-related autoimmune flares. It also proposes a practical vaccination strategy for rheumatology care and highlights key research gaps.<\/jats:p>","DOI":"10.1136\/rmdopen-2026-006994","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T15:15:30Z","timestamp":1779117330000},"page":"e006994","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Recombinant zoster vaccine in patients with inflammatory rheumatic diseases: efficacy, long-term protection and safety under immunosuppression"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1842-0754","authenticated-orcid":false,"given":"Marco","family":"Krasselt","sequence":"first","affiliation":[{"name":"Rheumatology, Medical Clinic III: Endocrinology, Nephrology and Rheumatology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig Medical Centre, Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"2026051808152352000_12.2.e006994.1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-215882"},{"key":"2026051808152352000_12.2.e006994.2","doi-asserted-by":"crossref","DOI":"10.3390\/vaccines11040760","article-title":"Influenza, Pneumococcal and Herpes Zoster Vaccination Rates in Patients with Autoimmune Inflammatory Rheumatic Diseases","volume":"11","author":"Krasselt","year":"2023","journal-title":"Vaccines (Basel)"},{"key":"2026051808152352000_12.2.e006994.3","doi-asserted-by":"crossref","DOI":"10.1093\/rheumatology\/keag043","article-title":"Shingles vaccination in immune-mediated inflammatory diseases: a narrative review","volume":"65","author":"Ark","year":"2026","journal-title":"Rheumatology (Oxford)"},{"key":"2026051808152352000_12.2.e006994.4","doi-asserted-by":"crossref","first-page":"2503","DOI":"10.1007\/s10067-024-07041-z","article-title":"Prior herpes zoster occurrence and high-dose corticosteroids increase herpes zoster risk in rheumatoid arthritis patients receiving janus kinase inhibitors in a retrospective and observational study","volume":"43","author":"Chen","year":"2024","journal-title":"Clin Rheumatol"},{"key":"2026051808152352000_12.2.e006994.5","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s40744-021-00390-0","article-title":"Clinical Management of Herpes Zoster in Patients With Rheumatoid Arthritis or Psoriatic Arthritis Receiving Tofacitinib Treatment","volume":"9","author":"Winthrop","year":"2022","journal-title":"Rheumatol Ther"},{"key":"2026051808152352000_12.2.e006994.6","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1002\/acr.25045","article-title":"2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases","volume":"75","author":"Bass","year":"2023","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026051808152352000_12.2.e006994.7","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.vaccine.2013.11.008","article-title":"Different vaccination strategies in Spain and its impact on severe varicella and zoster","volume":"32","author":"Gil-Prieto","year":"2014","journal-title":"Vaccine (Auckl)"},{"key":"2026051808152352000_12.2.e006994.8","doi-asserted-by":"crossref","DOI":"10.1080\/21645515.2023.2278362","article-title":"Recombinant zoster vaccine in immunocompetent and immunocompromised adults: A review of clinical studies","volume":"19","author":"Mwakingwe-Omari","year":"2023","journal-title":"Hum Vaccin Immunother"},{"key":"2026051808152352000_12.2.e006994.9","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7103a2"},{"key":"2026051808152352000_12.2.e006994.10","unstructured":"Updated recommendations on herpes zoster vaccination for adults who are immunocompromised. Public Health Agency of Canada; 2025. Available: https:\/\/www.canada.ca\/en\/public-health\/services\/publications\/vaccines-immunization\/national-advisory-committee-immunization-summary-updated-recommendations-herpes-zoster-vaccination.html"},{"key":"2026051808152352000_12.2.e006994.11","unstructured":"Impfempfehlung herpes zoster: Robert Koch-Institut, St\u00e4ndige Impfkommission (STIKO). 2026. Available: https:\/\/www.rki.de\/SharedDocs\/FAQs\/DE\/Herpes_zoster\/FAQ-Liste_Impfempfehlung.html"},{"key":"2026051808152352000_12.2.e006994.12","unstructured":"Erweiterung der Indikationsimpfempfehlung zur Herpes-zoster-Impfung mit dem adjuvantierten Subunit-Totimpfstoff f\u00fcr Personen \u226518 Jahre mit erh\u00f6htem Risiko, an Herpes zoster zu erkranken: Robert Koch-Institut, St\u00e4ndige Impfkommission (STIKO). 2025. 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