Coadministration of zoster vaccine, COVID-19 booster appears safe, effective

Coadministration of an mRNA COVID-19 booster vaccine with a first dose of recombinant zoster vaccine appeared safe and effective in a recent industry-conducted trial.

Researchers randomly assigned adults ages 50 years and older to receive a 50-µg booster dose of the Moderna mRNA monovalent COVID-19 vaccine and a first dose of recombinant zoster vaccine at the same time or two weeks apart. Both groups received the second zoster vaccine dose two months after the first and were then followed for at least six months. The trial's primary outcome was antiglycoprotein E and anti-spike protein antibody responses, with safety and reactogenicity as secondary outcomes. GlaxoSmithKline Biologicals SA funded and conducted the study. The results were published June 19 by Clinical Infectious Diseases.

The trial was conducted at 47 U.S. sites between Oct. 7, 2021, and Aug. 29, 2022. Overall, 273 patients were assigned to the sequential group and 272 were assigned to the coadministered group. Median age was 61 years (range, 50 to 88 years), and 56% were female. The adjusted geometric mean concentration ratio for sequential versus coadministration was 1.01 (95% CI, 0.89 to 1.13) for antiglycoprotein E antibodies one month after the zoster vaccine and 1.09 (95% CI, 0.90 to 1.32) for anti-spike protein antibodies one month after the COVID-19 booster. The two groups had no clinically relevant differences in overall frequency, intensity, or duration of adverse events. Most adverse events were mild or moderate, and they lasted for a median of less than 2.5 days, with pain at the vaccine site and myalgia the most frequently reported.

The researchers noted that the trial was open label, used a monovalent mRNA vaccine, and evaluated response after the first zoster vaccine dose but not the second. They concluded that coadministration of an mRNA COVID-19 booster vaccine and a first dose of a zoster vaccine was noninferior to sequential administration and had a similar safety and reactogenicity profile.

“These results provide important data that was previously lacking, to support both the public health agencies whose guidance to health care providers has been that COVID-19 vaccines can be administered without regard to timing of other age-appropriate vaccines, as well as those that are awaiting such data to make evidence-based and unreserved recommendations,” the authors wrote. “It is expected that coadministration of age-appropriate, recommended vaccines at a single clinic visit could be beneficial, especially for older adults, and by increasing coverage rates lead to a decrease in morbidity and mortality due to vaccine preventable diseases.”