The U.S. Food and Drug Administration, the Advisory Committee on Immunization Practices, and the American College of Rheumatology have stated that the live attenuated herpes zoster (HZ) vaccine is contraindicated in patients treated with certain immunosuppressive medications, including all biologic drugs, some non-biologic immunosuppressive drugs (such as methotrexate), and glucocorticoids (such as prednisone). The concern, of course, is that arthritis patients treated with immunosuppressive drugs may develop varicella (shingles) infection from the live virus strain contained in the vaccine.
Researchers studied the association between the HZ vaccine and HZ incidence, within and following the 42 day period after receiving the vaccine, in patients with certain immune-mediated diseases -- a population of patients with a known elevated risk of HZ. The study group included patients with rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel disease, treated with biologic or other immunosuppressive drugs. Data from Medicare claims, between January 1, 2006 and December 31, 2009, was used.
According to study results published in the July 4, 2012 issue of the Journal of the American Medical Association (JAMA), receipt of the HZ vaccine was not linked to a short-term increase in HZ incidence. Over a median of 2 years follow-up, there was actually a lower incidence of HZ. Researchers concluded that since the live HZ vaccine may not be linked to increased risk of developing HZ shortly after vaccination, there is need for a study that addresses the safety and effectiveness of the HZ vaccine, specifically in patients receiving treatment with biologic drugs. If you are considering the shingles vaccine, talk to your doctor. For now, the contraindication still holds. More studies are needed before that would change.
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