Shingles Vaccination in Immunocompromised Patients

Vaccine Selection

The Infectious Diseases Society of America guidelines recommend that live viral vaccines, such as Zostavax, should not be administered to highly immunocompromised patients, including those with Felty syndrome and severe chronic neutropenia, due to the risk of disseminated vaccine-strain infection 1, 2, 3
The American College of Immunology suggests that patients with congenital or cyclical neutropenia can receive live viral vaccines because their immune defect is limited to neutrophil production, with preserved lymphocyte function 1, 2
The Centers for Disease Control and Prevention recommend that Shingrix, a recombinant zoster vaccine, is the preferred option for immunocompromised patients, including those with Felty syndrome and severe chronic neutropenia, as it carries no risk of vaccine-strain infection 4, 5

The Infectious Diseases Society of America guidelines recommend administering Shingrix (two doses, 2-6 months apart) to patients with Felty syndrome and severe chronic neutropenia to provide protection against herpes zoster without the safety concerns of live vaccination 5
The American College of Immunology suggests that all inactivated vaccines, including pneumococcal vaccines (PCV13 followed by PPSV23), should be administered per CDC schedule to patients with Felty syndrome, given their high infection risk 1, 2, 3

The European League Against Rheumatism recommends that patients with Felty syndrome often require G-CSF therapy to manage neutropenia, but this does not change vaccine recommendations 4, 5
The American College of Rheumatology suggests that if the patient is on low-dose immunosuppression only, Shingrix remains the safer choice for vaccination against herpes zoster, despite some guidelines suggesting live-attenuated vaccine could theoretically be considered 4, 5