TUESDAY, July 3 (HealthDay News) -- For those suffering from the
chronic skin disorder psoriasis and other autoimmune diseases, a new
study finds the shingles vaccine appears to be both safe and effective.
It had been thought the vaccine might boost the risk of developing shingles in these patients, the researchers explained.
"The findings are reassuring for a very specific group of patients,"
said Dr. Bruce Hirsch, an attending physician in infectious diseases at
North Shore University Hospital in Manhasset, N.Y., who was not involved
in the study.
"Patients who have weak immune systems are vulnerable to getting shingles and the shingles vaccine is a live vaccine," he added.
The study looked at patients with rheumatoid arthritis, psoriasis,
psoriatic arthritis, ankylosing spondylitis (an inflammation of the
spine), or inflammatory bowel disease.
The risk is that patients with these conditions are taking drugs that
work by suppressing the immune system, which can leave them at risk for
infections.
"I would tell these patients to have the vaccine," Hirsch said. "The
vaccine seems to be effective and provides some advantage in patients
who are getting treatment for these conditions."
This study, however, does not address the vaccine in patients who
have weakened immune systems related to other causes, Hirsch said.
He cautions that the vaccine does have some risks and there is no long-term data on its effectiveness in these patients.
"I don't consider this study to be completely definitive," Hirsch
said. "The book isn't closed, but I am cautiously optimistic. The
vaccine seems to be safe and these kinds of patients are able to handle
the vaccine and get a benefit from it."
Because the shingles vaccine is a live vaccine, the U.S. Food and
Drug Administration and other organizations say the vaccine should not
be used in patients taking immunosuppressive drugs including all
biologic agents and some nonbiologics.
The concern is that these patients may develop shingles from the vaccine virus strain, the researchers explained.
"A live attenuated vaccine reduces [shingles] risk by 70 percent and
51 percent among immunocompetent individuals 50 to 59 years and 60 years
and older in two randomized, blinded trials, respectively," the
researchers wrote.
"The risk of [shingles] is elevated by 1.5 to two times in patients
with rheumatic and immune-mediated diseases such as rheumatoid arthritis
and Crohn's disease. This increase has been attributed to both the
underlying disease process and treatments for these conditions," the
authors added in the report published July 4 in the
Journal of the American Medical Association.
For the study, a team led by Jie Zhang, of the University of Alabama
at Birmingham, collected data on more than 460,000 Medicare patients who
had one of several rheumatic or immune-mediated diseases.
Specifically, they looked at the cases of shingles that developed in
the months after being vaccinated with the shingles vaccine.
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, the
researchers found.
There was only one case of shingles seen among all the patients during that time, they noted.
More than 42 days after being vaccinated, 138 patients did develop
shingles, which is in the range of the effectiveness of the vaccine, the
researchers reported.
All in all, after two years of follow-up, the investigators concluded
that the vaccine reduces the risk of shingles in these patients.
That conclusion was also based on accounting for the type of immune disease, treatment, the use of arthritis drugs and steroids.
"Despite the recognition that patients with immune-mediated
conditions are at increased risk of [shingles], this and previous
studies have shown that only a small fraction of these patients received
the vaccine, likely in part due to safety concerns. 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," Zhang's group concluded.
Another expert, Dr. Doris Day, a dermatologist at Lenox Hill Hospital
in New York City, said that "the shingles vaccine is a little
controversial, but as a dermatologist who sees shingles, I can tell you
that it can be a very painful, scarring process that goes beyond the
skin and lasts beyond the rash."
Currently, the vaccine is recommended for those aged 60 and over.
Shingles tends to be more severe and painful in older patients, she
noted.
"I recommend that people get the vaccine no matter what their underlying disease state or health," Day added.
SOURCES: Doris Day, M.D., dermatologist, Lenox Hill Hospital, New
York City; Bruce Hirsch, M.D., attending physician, infectious
diseases, North Shore University Hospital, Manhasset, N.Y.; July 4,
2012,
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