Can We Safely and Effectively Vaccinate Patients Receiving Biologic Therapies for Immune-Mediated Disease?

Indications are promising but not definitive; nevertheless, we should discuss results with patients who request the herpes zoster vaccine.

This question is important, as the risk for herpes zoster is elevated in older adults, more so in patients with immunologically mediated diseases. Most labels for biologic therapies suggest that immunization with live vaccine is contraindicated because of a fear that these individuals may develop varicella infection. Therefore, clinicians are hesitant to administer the "shingles" shot, and I have followed this practice with patients who request the vaccine.

These authors retrospectively assessed the rate of herpes zoster infection within 42 days of vaccination in 463,541 Medicare beneficiaries older than 60 being treated for rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, or inflammatory bowel disease. They also compared long-term risks for developing zoster in vaccinated versus nonvaccinated patients. Vaccinated patients were statistically less likely to develop zoster in the long term, including the 633 who were receiving biologic therapies at the time of vaccination. No recipients of biologic therapies developed zoster within 42 days of vaccination.

Citation(s):

Zhang J et al. Association between vaccination for herpes zoster and risk of herpes zoster infection among older patients with selected immune-mediated diseases. JAMA 2012 Jul 4; 308:43.