In the SPS (Shingles Prevention Study) safety analysis, Simberkoff and colleagues (1) concluded that "herpes zoster vaccine was well tolerated and safe in older immunocompetent adults," which supports recommendations for routine use. We are concerned that these published recommendations and product labeling specifically include nursing facility residents (2, 3). The SPS did not include participants who were immunocompromised, had significant cognitive impairment, were nonambulatory, or had limited life expectancy. In fact, overall mortality in SPS participants was less than half of what would be expected in the general population.
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