From Our 2012 Archives
Shingles Vaccine May Be OK for Autoimmune Patients
Study: Vaccine Cuts Shingles Risk for People Taking Immunity Suppressing Drugs
By Denise Mann
Reviewed by Louise Chang, MD
July 5, 2012 -- The live-virus shingles vaccine may be safe for people with autoimmune conditions and for those taking immunity-suppressing drugs.
The provocative finding comes from a study of 463,541 people aged 60 and older with rheumatoid arthritis, psoriasis, inflammatory bowel disease, or other autoimmune conditions such as psoriatic arthritis and ankylosing spondylitis. Some of these people were taking powerful biologic drugs that fight autoimmune disease but leave a person vulnerable to infections.
More than 18,600 of these people got the shingles vaccine, including 633 who were taking or had taken biologic drugs. None of the participants taking biologics developed shingles or related disease in the 42 days after getting the shot. Overall, vaccination was linked to a 39% lower risk of getting shingles over a follow-up period of about two years.
People with autoimmune disease, particularly those on biologic drugs, are at high risk of shingles. But it's been feared that instead of protecting against shingles, the live-virus vaccine might actually cause shingles in these patients.
"This is among the first clinical data that I have seen to call into question this contraindication," says study author Jeffrey R. Curtis, MD. "I think it is provocative."
Curtis, a rheumatologist at the University of Alabama at Birmingham, warns that the study findings must be confirmed before people with immune suppression are cleared to get the shingles vaccine.
"More studies are needed to back up these findings before changing current recommendations," he says. "I would be pretty nervous about telling someone it is okay when every recommendation says not to do it."
Shingles Dangerous for People With Autoimmune Disease
Shingles is much worse than a bad rash.
"Shingles -- herpes zoster -- causes blistering rashes around the trunk that last 10 to 14 days," Curtis says. "But 20% of people have chronic and lifelong pain."
Shingles occurs when chickenpox virus lying dormant at nerve roots reactivates, travels up the nerves, and causes painful blisters at the nerve endings in the skin. Anyone who has had chickenpox can get shingles, but people with weakened immune systems are most at risk. The CDC recommends a single dose of the shingles vaccine for people aged 60 and older.
But the FDA and other medical groups recommend against giving the vaccine to people taking biologic drugs such as TNF-blockers and other medications that suppress the immune system, including steroids. Medications that suppress the immune system can help people with autoimmune conditions, but they also leave them more vulnerable to infections -- including infections from live-virus vaccines that are safe in people with normal immunity.
David Pisetsky, MD, PhD, says he would consider vaccinating people on biologic drugs against shingles. He is the chief of rheumatology at Duke University Medical Center in Durham, N.C.
"We should relook at this question," he says. "TNF-blockers will be mainstays of therapy for some time to come, and we need to ask questions like, 'What happens if you vaccinate?'"
This study does not provide enough data to change the recommendation yet, but it calls for more research. "We always worry with live vaccines," Pisetsky says.
People who take TNF-blockers to treat RA, psoriasis, or other autoimmune diseases need to be careful about developing an infection of any kind. This is why they are pre-screened for tuberculosis and told to be aware of the signs and symptoms of an infection, he says.
The Curtis study appears in the July 4 issue of the Journal of the American Medical Association.
SOURCES: Zhang, K. Journal of the American Medical Association, July 4, 2012. Jeffrey R. Curtis, MD, rheumatologist, University of Alabama at Birmingham. David Pisetsky, MD, chief of rheumatology, Duke University Medical Center, Durham, N.C.
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