Infectious Diseases A-Z: New shingles vaccine should soon be available
Study Supports Wider Use of Shingles Vaccine
The live attenuated herpes zoster vaccine is regarded as contraindicated for older people being treated for immune mediated-diseases, largely because of fears that the vaccine strain will cause disease.
By Michael Smith, MedPage Today
Medically Reviewed byZalman S Agus, MD
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THURSDAY, July 5, 2012 (MedPage Today) —The shingles vaccine appears safe in older patients with immune-mediated diseases such as rheumatoid arthritis and Crohn's disease, researchers reported.
In a retrospective analysis of more than 460,000 Medicare beneficiaries, the herpes zoster vaccine was not associated with an increased rate of herpes zoster disease in the weeks after immunization, according to Jeffrey Curtis, MD, of the University of Alabama Birmingham, and colleagues.
Also, in a multivariable analysis, the vaccine was associated with a 39 percent lower risk of herpes zoster disease after the 42 days immediately following vaccination, Curtis and colleagues reported in the July 4 issue of theJournal of the American Medical Association.
The live attenuated vaccine is regarded as contraindicated for older people being treated for immune mediated-diseases, largely because of fears that the vaccine strain will cause disease, the authors noted.
But "our data call into question" that recommendation, and suggest that the vaccine's efficacy and safety should be tested in a randomized, controlled trial among patients treated with biologic agents for immune-mediated diseases, they concluded.
Those data come from analysis of Medicare claims data for 463,541 Medicare beneficiaries, 60 and older, with rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, or inflammatory bowel disease from Jan. 1, 2006, through Dec. 31, 2009.
The outcome measures were herpes zoster incidence within 42 days of vaccination mdash; a risk window based on the incubation period of varicella zoster virus mdash; as well as disease incidence after that period.
Compared with the general population, the risk of herpes zoster is 1.5- to twofold higher in patients with rheumatic and immune-mediated diseases, the authors noted. On the other hand, in the general population, the vaccine reduced the risk of herpes disease by 51 percent in a randomized trial among people 60 and older.
In their cohort, the researchers found that the average age of the participants was 74, with a 2-year median follow-up. During the study period, 18,683 patients (or 4 percent) received the zoster vaccine.
Among 633 patients taking biologic agents, including 551 taking antitumor necrosis factor drugs, there were no cases of varicella or herpes zoster within the 42-day safety window. Over all forms of treatment, including both biologics and other immune-suppressing drugs, the researchers found only one case of varicella in the 42-day window.
In the period after the safety window closed, Curtis and colleagues found 138 herpes zoster cases among the vaccinated patients over 20,639 person-years of follow-up.
That resulted in an incidence rate of 6.7 cases per 1,000 person-years, they reported, contrasting sharply with the rate among those who did not receive the vaccine of 11.6 cases per 1,000 person-years.
In an analysis controlling for demographics, the type of immune-mediated disease, healthcare use, and exposure to various forms of therapy, the adjusted hazard ratio for herpes disease associated with vaccination was 0.61.
The researchers cautioned that although they observed no early cases among vaccinated patients also taking biologics, the risk may not be zero because the upper limit of the 95 percent confidence interval was 4.7 cases per 1,000 person-years.
They added that it was not possible to tell whether the cases they observed within the overall vaccinated population were the vaccine strain or wild type.
Also, they noted that the study used administrative data that was not confirmed with medical records.
Video: June 2017 ACIP Meeting - Herpes Zoster Vaccine
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