The herpes zoster (HZ) virus is associated with significant morbidity. Its incidence and severity are higher among older adults and immunocompromised individuals. This systematic review assessed the clinical efficacy and effectiveness of recombinant zoster vaccine (RZV) for the prevention of HZ and associated complications in adults at least 50 years of age and in adults (≥18 years) at increased risk of HZ.

Electronic searches restricted to between 2008 and July 2023 were conducted in Embase, MEDLINE, the Cochrane Library, and clinical trial registries. Two reviewers independently screened articles and extracted data. The review adhered to the PRISMA reporting guidelines. Quality appraisal was assessed using version two of the Cochrane risk-of-bias tool for randomized trials tool and the Risk of Bias in Non-Randomized Studies - of Interventions tool. Meta-analysis was undertaken using Cochrane methodology, with preference given to random effects meta-analysis because of study heterogeneity.

Twelve RCTs and five cohort studies were identified. Vaccine efficacy was defined as one minus the incidence rate ratio, multiplied by 100. For the general population, vaccine efficacy was 92 percent (n=29,311 individuals) and vaccine effectiveness was 70 percent (n=43,990,671 individuals). Based on one trial, vaccine efficacy in the general population (aged ≥50 years) waned from an initial 97.7 percent to 73.2 percent by year 10. Two RCTs reported vaccine efficacy for those at increased risk: 68.2 percent in hematopoietic stem cell transplant recipients and 87.2 percent in those with hematological malignancies. Secondary analyses were limited by sample size.

There is clear, consistent evidence that RZV is effective in reducing HZ incidence. Although the vaccine is effective in those who are least 18 years of age and are at increased risk of HZ, efficacy may be lower compared with a general population aged at least 50 years. Secondary analyses (age subgroups, HZ complications, and HZ-related hospitalizations) were limited by small sample size, leading to inconclusive results.

Herpes zoster (HZ), also known as shingles, is characterized by a vesicular skin rash, often associated with acute pain and itching. The safety profile of the recombinant zoster vaccine (RZV) in adults aged 50 years and older and in adults aged 18 and older who are at increased risk of HZ was assessed in this systematic review.

A comprehensive electronic search was performed in Embase, MEDLINE, the Cochrane Library, and clinical trials registries. Searches were limited to the period from 2008 to July 2023. Article screening and data extraction were carried out by two independent reviewers. Risk of bias was assessed using the Cochrane revised Risk of Bias 2 (RoB2) tool for randomized controlled trials (RCTs). The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool was used to assess the quality of non-randomized studies. An adapted version of the Newcastle–Ottawa Scale was used for the appraisal of quality of non-comparative studies.

Eighteen RCTs, four observational cohort studies, seven single-arm trials, and 11 single-arm observational studies were identified. Compared with placebo, solicited local (RZV: 74.1 to 84.0%; placebo: 7.9 to 11.9%) and systemic reactions (RZV: 53.0 to 66.1%; placebo: 6 to 11.4%) were more common in the vaccinated cohorts. Reactions were generally transient and mild to moderate in intensity. The most frequent reactions reported were pain at the reaction site, fatigue, and myalgia. The incidence of potential immune-mediated diseases (pIMDS), serious adverse events (SAEs), and fatalities was similar in vaccine and placebo groups. No SAEs, pIMDs, or deaths were reported as vaccine related.

The available data on RZV shows that while local and systemic adverse events are common with RZV, these are typically transient, and SAEs are uncommon in both the general population and those at increased risk of HZ.

We identify a set of essential recent advances in climate change research with high policy relevance, across natural and social sciences: (1) looming inevitability and implications of overshooting the 1.5°C warming limit, (2) urgent need for a rapid and managed fossil fuel phase-out, (3) challenges for scaling carbon dioxide removal, (4) uncertainties regarding the future contribution of natural carbon sinks, (5) intertwinedness of the crises of biodiversity loss and climate change, (6) compound events, (7) mountain glacier loss, (8) human immobility in the face of climate risks, (9) adaptation justice, and (10) just transitions in food systems.

The Intergovernmental Panel on Climate Change Assessment Reports provides the scientific foundation for international climate negotiations and constitutes an unmatched resource for researchers. However, the assessment cycles take multiple years. As a contribution to cross- and interdisciplinary understanding of climate change across diverse research communities, we have streamlined an annual process to identify and synthesize significant research advances. We collected input from experts on various fields using an online questionnaire and prioritized a set of 10 key research insights with high policy relevance. This year, we focus on: (1) the looming overshoot of the 1.5°C warming limit, (2) the urgency of fossil fuel phase-out, (3) challenges to scale-up carbon dioxide removal, (4) uncertainties regarding future natural carbon sinks, (5) the need for joint governance of biodiversity loss and climate change, (6) advances in understanding compound events, (7) accelerated mountain glacier loss, (8) human immobility amidst climate risks, (9) adaptation justice, and (10) just transitions in food systems. We present a succinct account of these insights, reflect on their policy implications, and offer an integrated set of policy-relevant messages. This science synthesis and science communication effort is also the basis for a policy report contributing to elevate climate science every year in time for the United Nations Climate Change Conference.

We highlight recent and policy-relevant advances in climate change research – with input from more than 200 experts.