Flares Following Herpes Zoster Recombinant Zoster Vaccination Among Adults Age > 50 Years with Immune Mediated Inflammatory Diseases in the United States
Authors: Jeffrey Curtis al.
Patients with immune mediated inflammatory diseases (IMDs) are at increased risk of herpes zoster (HZ). However, patients are hesitant with vaccines because of the fear that vaccination could cause their underlying immune disease to flare. The authors of this American study used two large insurance databases to study the incidence of flares of the underlying diseases 3 months before and 1.5 months after a recombinant HZ vaccination. In the ~ 80’000 patients with an IMID who were vaccinated against HZ, 10% had developed a flare during the control period (prior to vaccination) and 9% developed a flare after the vaccination. The authors concluded that HZ vaccination does not appear to increase the incidence of flares in patients who have underlying IMIDs.
Swiss Health Authorities (BAG/OFSP) recommend HZ vaccination in this group for patients older than 50. The available vaccine against HZ is a life-attenuated vaccine (Zostavax®), which is contraindicated in patients receiving immunosuppressant, which explains probably why this vaccination is currently not much practiced. A recombinant HZ vaccination (Shingrix®) is already approved in the EU-countries and should soon be approved in Switzerland, and can already be ordered from neighboring countries. The vaccination appears to be safe in elderly populations of patients with IMIDs and does not appear to increase significantly the likelihood of disease flares.