Effectiveness of the Recombinant Zoster Vaccine for Herpes Zoster Ophthalmicus in the United States.

Abstract Purpose To examine the effectiveness of the recombinant zoster vaccine for preventing herpes zoster ophthalmicus in the general US population. Design Retrospective, observational cohort study. Participants Individuals enrolled in the OptumLabs® Data Warehouse (OLDW) (OptumLabs, Cambridge, MA) who were age-eligible for herpes zoster vaccination (≥50 years old) from 2018 through 2019. OLDW is a longitudinal, de-identified administrative claims and electronic health record database of patients in the United States with commercial insurance, Medicare Part D or Medicare Advantage Methods Patients were required to have ≥365 days of continuous enrollment to be eligible. Those with a diagnosis code of herpes zoster or an immunocompromising condition within one year prior to study inclusion were excluded. Vaccination with the recombinant zoster vaccine was ascertained by CPT codes, and herpes zoster ophthalmicus was ascertained by ICD-10 codes. Cox proportional hazards regression models were used to estimate the hazard ratio of HZO associated with RZV, and inverse-probability weighting was used to control for confounding. Vaccine effectiveness was calculated from hazard ratios. Main Outcome(s) and Measure(s) Incidence of herpes zoster ophthalmicus in vaccinated vs. unvaccinated person-time and vaccine effectiveness were assessed. Results From January 1, 2018 to December 31, 2019 a total of 4 842 579 individuals were included in this study. 177 289 (3.7%) received two valid doses of RZV. The incidence rate of herpes zoster ophthalmicus was 25.5 (95% CI: 17.4, 35.8) cases per 100 000 person-years in the vaccinated group compared to 76.7 (95% CI: 74.7, 78.7) in the unvaccinated group. The overall adjusted effectiveness of RZV against herpes zoster ophthalmicus was 89.1% (95% CI: 82.9, 93.0). Conclusions The effectiveness of RZV against herpes zoster ophthalmicus in individuals ages 50 years old and above is high in a real-world setting. However, the low vaccination rate in this study highlights the public health need to increase herpes zoster vaccination. Ophthalmologists can play an important role in recommending vaccination to eligible patients.