Herpes zoster vaccination in inflammatory bowel disease: Evidence, guidelines, and reality

Table 6 Key studies on recombinant zoster vaccine in inflammatory bowel disease - efficacy against herpes zoster and complications

Ref.	Study	Population	Sample size	Key findings on HZ/complications	Vaccine effectiveness/HR/OR (95%CI)	Complications
Desai et al[39], 2024	Propensity-matched United States cohort	Adults ≥ 50 years with IBD (UC/CD)	5489 vaccinated (2 doses) vs 5265 unvaccinated (after PSM: Approximately 4774 per group)	Lower HZ incidence post-RZV; reduced short-term HZ risk. No significant difference in severe complications or PHN among those with HZ	aOR = 0.44 (0.32-0.62) for HZ; incidence 109 vs 24.2 per 1000 PY	Prevention-focused; no major difference in PHN/severe HZ post-onset
Tseng et al[37], 2025	Kaiser Permanente matched cohort	Adults ≥ 50 years with IBD	872 (2-dose vaccinated) vs 2550 unvaccinated (VE cohort); 1199 in SCCS for flares	Adjusted VE 65.1% against HZ; no increased IBD flare risk	VE 65.1% (24.8%-83.8%) against HZ	Supports HZ prevention (implying lower complications); no flare increase [RR = 0.80 (0.47-1.35)]
Wang et al[38], 2025	TriNetX real-world matched analysis	Adults with IBD (mixed ages, primarily adults)	1260 vaccinated vs 1260 unvaccinated (after matching from n = 12086)	Significantly lower HZ complications (PHN, CNS); no CNS cases in vaccinated. Stronger in UC, females, non-immunosuppressed	HR = 0.75 (0.58-0.97) for HZ complications; HR = 0.66 for PHN; uncomplicated HZ HR = 0.31 (0.26-0.37)	Direct complication reduction: PHN 5.8% vs 12.5%; CNS 0% vs 0.8%; ocular/disseminated similar
Caldera et al[40], 2025	Prospective immunogenicity/safety	Adults with IBD on vedolizumab or anti-TNF	67 patients (33 enrolled: 16 vedolizumab, 17 anti-TNF)	Robust immunogenicity (sustained antibodies/CMI); no IBD flares; mild AEs	N/A (immunogenicity focus); strong responses through day 425	Low flare rate (1.5%); indirect benefit via HZ avoidance
Khan et al[42], 2022	ZOE-HSCT and broader immunocompromised (IBD overlap)	Immunocompromised adults ≥ 18 years (e.g., post-HSCT, hematologic; proxy for immunosuppressed IBD)	Varies (approximately 1800 in pivotal trials)	VE approximately 68% against HZ; high against PHN (approximately 89%). Lower NNV for complications in high-risk groups	VE 68.2% (55.6%-77.5%) against HZ; 89.3% against PHN	Proxy data; reduced PHN/hospitalization; comparable across ages

HSCT: Hematopoietic stem cell transplantation; IBD: Inflammatory bowel disease; UC: Ulcerative colitis; CD: Crohn’s disease; PSM: Propensity score matching; VE: Vaccine effectiveness; SCCS: Self-controlled case series; TNF: Tumor necrosis factor; HZ: Herpes zoster; RZV: Recombinant zoster vaccine; PHN: Post-herpetic neuralgia; CNS: Central nervous system; CMI: Cell-mediated immunity; AE: Adverse event; NNV: Number needed to vaccinate; HR: Hazard ratio; OR: Odds ratio; CI: Confidence interval; aOR: Adjusted odds ratio; PY: Patient-years; N/A: Not applicable; RR: Relative risk.