by Cooper B. Wilhelm
Current recommendations hold that people taking certain drugs used to treat some kinds of arthritis should not be vaccinated against herpes zoster. However, new research suggests the vaccine may actually be safe for these people.
Herpes zoster (commonly called shingles) is an adult form of chickenpox that is often far more serious than the childhood illness. It can cause significant pain and sometimes long-term complications. For people with rheumatic conditions such as rheumatoid arthritis (RA) and Crohn disease, the risk of developing shingles is as much as double the risk for the overall population.
The US Food and Drug Administration, American College of Rheumatology, and Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices all currently recommend that people taking certain drugs that mediate the immune system (such as many treatments for arthritis) not be given the shingles vaccine, which contains a live version of the virus. However, a study recently published in The Journal of the American Medical Association suggests these recommendations should be changed.
Using data from 463,541 people — all of whom had RA, psoriasis, psoriatic arthritis, ankylosing spondylitis, or inflammatory bowel disease — researchers looked at the rates of herpes zoster infection in people who had been vaccinated and people who had not. They also looked at the infection rates in people who had been treated with drugs that mediate the immune system.
These medicines included anti-tumor necrosis factor (anti-TNF) drugs, such as adalimumab (brand name Humira), etanercept (Enbrel), and infliximab (Remicade); disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (Rheumatrex, Trexall), hydroxychloroquine (Plaquenil, Quineprox), and sulfasalazine (Azulfidine); non-TNF biologic drugs, such as abatacept (Orencia) and rituximab (Rituxan); and oral glucocorticoids.
Of the people studied, 11,030 made Medicare claims for a vaccination against shingles between January 1, 2006, and December 31, 2009. Data were available for 7,780 of those people for the first 42 days after receiving the vaccination.
The researchers found that overall, those who were vaccinated had a lower rate of herpes zoster (7.8 cases per 1,000 person-years) than those who were not vaccinated (11.6 cases per 1,000 person-years).
Those who received the vaccination and had been exposed to one of the drugs above, regardless of which kind of drug, had a lower rate of infection in the first 42 days than the average rate of infection for unvaccinated people exposed to the same drug. In fact, although anti-TNF drugs are particularly noted for increasing the risk of contracting herpes zoster, none of the people exposed to biologics at the time of vaccination (including 551 exposed to anti-TNF drugs) developed herpes zoster within the first 42 days.
Overall, the rate of infection 42 days after vaccination for those vaccinated was nearly half (61%) of the average rate of infection for people without the vaccination. The rate of infection for those vaccinated also remained lower over a median 2 years of follow-up.
Limitations of the study included an inability to determine whether people who became infected with herpes zoster were infected with the same strain as was in the vaccine or by a different strain (which is to say, whether the vaccine may have caused the herpes zoster infections directly). It is also possible, given the increased susceptibility of people in the study to infection, that the 42-day window may have been too short to see if vaccination led to infection.
Last Reviewed on July 12, 2012
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