The inactivated herpes zoster vaccine HZ/su induces a varicella zoster virus specific cellular and humoral immune response in dialysis patients

To evaluate the immunogenicity of the inactivated herpes zoster vaccine HZ/su in patients at increased risk for VZV-reactivation, we analyzed the quantity and quality of the vaccine-induced cellular and humoral immunity in dialysis patients with uremic immunodeficiency. In this observational study, 29 patients and 39 immunocompetent controls underwent standard dual-dose vaccination. Blood samples were analyzed before and two weeks after each vaccination, and after one year. Specific T-cells were characterized after stimulation with VZV-gE peptides based on induction of cytokines and CTLA-4-expression using flow-cytometry. Antibodies were analyzed using ELISA. Both groups showed an increase in VZV-gE specific CD4 T-cell levels over time (p<0.0001), although median levels reached after second vaccination were lower in patients (0.17% (IQR 0.21%)) than in controls (0.24% (IQR 0.3%), p=0.042). VZV-gE specific CD8 T-cells were only poorly induced. CTLA-4 expression on VZV-gE specific CD4 T-cells was strongest after second dose with no differences between the groups (p=0.45). Multifunctional cells co-expressing IFNγ, IL-2, and TNF were higher in patients after first vaccination (p=0.028). Median VZV-specific IgG-levels reached a maximum after second vaccination with significantly lower levels in patients (10796 (IQR 12482) IU/l) than in controls (16899 (IQR 14019) IU/l, p=0.009). Despite similar CD4 T-cell levels after one year (p=0.415), antibody levels remained significantly lower in patients (p=0.0008). The VZV-gE vaccine induced specific antibodies and CD4 T-cells in both patients and controls, whereas CD8 T-cells were only poorly induced. Quantitative and qualitative differences in immunity in patients may indicate reduced duration of protection which may necessitate booster vaccinations.