Recombinant Herpes Zoster Vaccine in Immunosuppressed Rheumatology Patients: Real-World Safety Data from a Prospective Cohort Study in Saudi Arabia

Abstract Background: Patients with rheumatologic diseases, especially those receiving immunosuppressive therapy, have a heightened risk of developing herpes zoster (shingles). The recombinant zoster vaccine (RZV) provides effective protection, but its safety profile in this specific population remains to be established. Materials and Methods: A prospective cohort study was conducted at King Fahad Military Medical Complex in Dhahran, Saudi Arabia. This study examined immunosuppressed patients with autoimmune rheumatic diseases who received the RZV. Patients were monitored over 6 months for adverse events (AEs), disease flares, and serious AEs (SAEs). Results: The final analysis included 83 of 164 screened patients (68.7% female, mean age of 46.9 ± 10.5 years). A follow-up call was made 1 week aftereach dose to monitor for side effects. Completion of the second dose of the vaccine occurred in only 88% of the cohort. The vaccine was well-tolerated in all cases. Mild local reactions were the most frequently reported AE. A small proportion (4.8%) experienced disease flares, all of which were mild or moderate and resolved without complications. No SAEs were linked to the vaccine. Conclusion: In this prospective cohort, the RZV was well-tolerated among immunosuppressed rheumatology patients in Saudi Arabia, showing low rates of mild disease flares and no vaccine-related SAEs.