New research from the University of Alabama at Birmingham casts doubt on the long-standing belief that the vaccine for shingles should not be given to patients taking biologics for auto-immune diseases such as rheumatoid arthritis. The findings were published today in the Journal of the American Medical Association.
Shingles, or herpes zoster, is a reactivation in adults of the varicella virus that causes chicken pox in children. The U.S. Food and Drug Administration recommends a vaccine for shingles for people older than 60, but not for individuals taking anti-tumor necrosis factor therapies or other biologics commonly used to treat immune-mediated diseases.
"The vaccine is a live attenuated vaccine, and the long-standing opinion in the medical community is that patients with certain immune-related diseases receiving immunosuppressive therapies like biologics are at increased risk of contracting varicella from the vaccine itself," said Jeffrey Curtis, M.D., lead author of the study and associate professor in the division of Clinical Immunology and Rheumatology in UAB's School of Medicine. "However, that opinion has not been definitively bolstered by scientific studies."
Curtis and fellow researchers examined 463,541 Medicare patients 60 years and older with five immune-related conditions: rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis and inflammatory bowel disease. There were 633 patients who were exposed to biologics at the time of vaccination or within the next 42 days, the time normally associated with potential adverse reactions to a vaccine. Curtis reports that none of the 633 patients developed shingles in that time period.
"While we don't suggest that there is zero risk, our findings do suggest that the live shingles vaccine may not be associated with an increased risk of contracting varicella or reactivating shingles from the vaccine in this population," said Curtis. "Our data call into question the current recommendations from the FDA, the Advisory Committee on Immunization Practices and the American College of Rheumatology that the shingles vaccine is contraindicated in patients receiving biologics."