Shingles Vaccine Safe for More Patients

Arthritis and psoriasis patients may not be at greater risk for shingles

(RxWiki News) People taking immunity-suppressing drugs are currently advised against the live-virus shingles vaccine because there is concern that it could lead to shingles, for this population.

A new study shows that patients who take immunity-suppressing medications for rheumatoid arthritis, psoriasis, inflammatory bowel disease and related ailments, are not at higher risk for shingles if they get the vaccination.

"Consider getting a shingles vaccine if you are over 60."

Jie (Sophie) Zhang, PhD, a post-doctoral trainee in the Department of Epidemiology in the School of Public Health, at the University of Alabama at Birmingham, and colleagues, analyzed data of 463,541 Medicare beneficiaries who had autoimmune and inflammatory diseases.

The team found that 18,683 of these patients had received the shingles vaccine, Zostavax, and 633 had been treated with immunity suppressing drugs.

None of the 633 patients contracted shingles in the 42 days following vaccination.

Shingles (herpes zoster) is a painful, blistering skin rash caused by the varicella zoster virus.  This virus also causes chickenpox, according to the National Institutes of Health.

It usually clears up in two to three weeks and rarely recurs but it can cause temporary or permanent weakness or paralysis.  The pain in the infected area may last for months to years.

Half of the population that lives to age 85 will get shingles, and the risk increases after the age of 50, according to the US Centers for Disease Control and Prevention (CDC).

The risk of getting shingles is elevated by 1.5 to 2 times in patients with rheumatic and immune-mediated diseases, such as rheumatoid arthritis and Crohn's disease, according to Dr. Zhangs’s report.

The CDC recommends that most adults age 60 or older get a one-time shingles immunization because the vaccination has been shown to reduce the overall incidence of shingles in older adults by about 51 percent.

Dr. Zhang’s study stated that the vaccine reduced the risk of shingles by 70 percent and 51 percent among immunocompetent individuals 50 to 59 years old and 60 years and older, in two randomized blinded trials.

Currently, the US Food and Drug Administration and other organizations advise against the live-virus shingles vaccine for those taking immunity-suppressing drugs because they believe this group is more likely to get shingles.

Jeffrey Curtis, MD, MPH, corresponding author and assistant professor in the Division of Clinical Immunology and Rheumatology at University of Alabama at Birmingham, said that scientists have been concerned that the shingles vaccine, which contains a weakened live virus, would actually infect patients taking immunity-suppressing drugs rather than prevent them from getting sick.

"Despite the recognition that patients with immune-mediated conditions are at increased risk of herpes zoster, this and previous studies have shown that only a small fraction of these patients received the vaccine, likely in part due to safety concerns,” the authors concluded.

“Our data call into question the current recommendations that herpes zoster vaccine is contraindicated [advised against] in patients receiving biologics [immunity-suppressing drugs] and suggest a need for a randomized controlled trial to specifically address the safety and effectiveness of herpes zoster vaccination among patients receiving biologics,” they wrote.

This study was published in the Journal of the American Medical Association on July 4. This project was supported by the Agency for Healthcare Research and Quality (AHRQ). Dr. Zhang received support from the AHRQ, and Dr. Curtis received support from AHRQ and the National Institutes of Health.

Seven of the authors reported receiving research support, grants and/or consulting fees from various pharmaceutical companies, including Amgen, Pfizer, Centocor, Abbott, Millennium Pharmaceuticals, Takeda, Shire, Genentech/Roche and Merck.

Review Date: 
July 6, 2012