Is shingles vaccine safe for those with autoimmune diseases?

     Shingles is a neurocutaneous (nerves and skin) disease characterized by a painful blistery rash that results from the reactivation of the varicella-zoster (chickenpox) virus. Anyone who has had shingles might jump at the opportunity to obtain the shingles vaccine, but the live attenuated herpes zoster vaccine has been regarded as contraindicated for older patients being treated for immune-mediated diseases. A recently reported research study from the University of Alabama Birmingham would call that recommendation into question.

     In a retroactive analysis of more than 460,000 Medicare beneficiaries having one of several rheumatic or immune-mediated diseases, including rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, or inflammatory bowel disease, the herpes zoster vaccine was not associated with an increased rate of shingles in the weeks after immunization in this study, as reported by the research team headed by Dr. Jie Zhang. The researchers reported that among the over 18,600 patients who received the shingles vaccine, there were no cases of shingles in the 42 days after vaccination, including among the over 600 who were taking so-called anti-tumor necrosis factor biologics to treat their other conditions.

     Dr. Bruce Hirsch, an attending physician in infectious diseases at North Shore University, in Manhasset, New York, who was not involved in the study, says "I would tell these patients to have the vaccine." He continues, "The vaccine seems to be effective and provides some advantage in patients who are getting treatment for these conditions."

     Dr. Zhang says, "Our data call into question the current recommendations that [shingles] vaccine is contraindicated in patients receiving biologics and suggest a need for a randomized controlled trial to specifically address the safety and effectiveness of [shingles] vaccination among patients receiving biologics."

     Dr. Doris Day, dermatologist, Lenox Hill Hospital, New York City, says that, as a dermatologist who sees shingles, while the shingles vaccine is "a little controversial," she recommends that people get the vaccine "no matter what their underlying disease state or health."

--Sources: Excerpted from "Study Supports Wider Use of Shingles Vaccine," Michael Smith, MedPage Today, July 5, 2012; "Shingles Vaccine Safe for Those With Autoimmune Disease: Study," HealthDay, MedlinePlus, NIH U.S. National Library of Medicine, July 3, 2012