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.

M.S. has received grant support from Astellas and Biotest to the organization Saarland University outside the submitted work, and honoraria for lectures from Biotest and Novartis, and for advisory boards from Moderna, Biotest, MSD and Takeda outside the submitted work. T.S. has received travel grant support from Biotest outside the submitted work. All other authors of this manuscript have no conflicts of interest to disclose.

Financial support was provided in part by HOMFORexzellent (to D.S.).

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The study was approved by the ethics committee of the Arztekammer des Saarlandes (reference 27/19), and all individuals gave written informed consent.

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