Vaccination in adults at-increased risk of herpes zoster in Canada: insights from a multidisciplinary panel consensus
Bibliographic record
Abstract
BACKGROUND: Risk of herpes zoster (HZ) increases with age (notably at ≥50 years), with greater risk also apparent in immunocompromised populations. The use of the recombinant zoster vaccine (RZV) in adults aged ≥50 years is established in Canada. However, while licensed RZV use was expanded in 2021 to include individuals ≥18 years of age who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression caused by known disease or therapy, there remains some uncertainty for clinicians regarding which patients should be offered vaccination. RESEARCH DESIGN AND METHODS: To assist decision-making, a Canadian multidisciplinary panel was convened to develop guidance on the use of RZV in at-risk adults aged ≥18 years through a consensus approach, defined as ≥75% of the experts rating their agreement. RESULTS: The panel concluded that RZV should be offered to all at-risk individuals aged ≥18 years who are or will be at increased risk of HZ due to disease or therapy, in line with the licensed indication. This includes those with chronic medical conditions at greater risk of HZ (e.g. COPD, diabetes). Decisions should be individualized based upon patient assessment and shared clinical decision-making. Where possible, the two-dose vaccine series should be given at the earliest opportunity. CONCLUSIONS: Findings from this expert consensus provide guidance on the use of RZV in individuals ≥18 years at increased risk of HZ. Our views complement updated national recommendations for immunocompromised patients issued in May 2025.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.029 | 0.062 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.007 | 0.002 |
| Scholarly communication | 0.004 | 0.001 |
| Open science | 0.003 | 0.005 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".