Zostavax, a live attenuated vaccine, has been approved in the U.S. for use in older individuals, over the age of 50, to reduce the risk of developing the infection of shingles (herpes zoster). This infection is essentially a re-activation of the same virus that causes chickenpox. The virus remains sleeping in the body and can manifest itself as a painful, blistering rash in later adulthood. To what extent is the vaccine used by older individuals, is it effective, and is it safe for patients with, specifically, rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, and/or inflammatory bowel diseases?

It has been accepted that the herpes zoster vaccine, which contains a weakened version of the live virus, is contraindicated in individuals taking anti-tumor necrosis factor (anti-TNF) therapies or other biologics commonly used to treat autoimmune disease. This is because of a safety concern that the vaccine may be associated with a short-term herpes zoster risk.

The results of the study by researchers from the University of Alabama, at Birmingham, Alabama, and the Oregon Health Science University, Portland, Oregon, involving 44,115 patients, ages 50 and over, with autoimmune diseases showed that the use of the zoster vaccine was uncommon among older AD patients (1.2 percent), including those not exposed to immunosuppressive medications. Younger and healthier patients, those who had a herpes zoster infection within the past six months and those not using anti-TNF therapies were more likely to receive the vaccine.

Approximately 6 percent of the vaccinated patients were using anti-TNF therapies at the time of vaccination, and the incidence rates of herpes zoster were similar in vaccinated and unvaccinated patients. The short-term risk of herpes zoster did not appear to be increased in vaccinated patients, even among those using immunosuppressive therapies, e.g., biologics, at the time of vaccination. The incidence rates of herpes zoster were similar in vaccinated and unvaccinated patients.

These findings led the researchers to conclude that people taking biologics may be able to receive the zoster vaccine safely and may not be at an increased, short-term risk of developing shingles from the vaccine.

--Source: "The use, safety and effectiveness of herpes zoster vaccination in individuals with inflammatory and autoimmune diseases: a longitudinal observational study," Arthritis Research & Therapy, October 24, 2011, via 7th Space Interactive; "Shingles Vaccine Doesn't Increase Short Term Risk in People Taking Biologics for Autoimmune and Inflammatory Diseases," American College of Rheumatology, November 1, 2011, via newswise