Safety concerns surrounding the receipt of the herpes zoster (shingles) vaccine by patients receiving certain immunosuppressive medications have resulted in recommendations against use of the vaccine in these patients. To evaluate these recommendations, researchers retrospectively analyzed a cohort of 463,541 Medicare patients older than 60 years with immune-mediated diseases: 4,026 with ankylosing spondylitis; 66,751 with inflammatory bowel disease; 11,030 with psoriatic arthritis; 89,565 with psoriasis; and 292,169 with rheumatoid arthritis. Rates of shingles among vaccine recipients undergoing drug therapy for one of these immune-mediated conditions were compared with rates in unvaccinated patients taking the same medications.

Among patients who were not vaccinated, the incidence of shingles varied according to medication but was significantly elevated in each medication group studied; glucocorticoid use, for instance, was associated with a 1.2-to-2-fold-higher risk of shingles.

Among the 7,780 patients who were vaccinated (and for whom there were follow-up data), there was no greater incidence of shingles than among those who weren't vaccinated. In fact, none of the 633 patients receiving biologics plus the vaccine developed shingles or chickenpox (varicella) within the first 42 days after vaccination. The incidence after 42 days (with a median follow-up of two years) also was not greater: after adjustment for a number of factors, such as type of immune-mediated disease and medication exposure, the hazard ratio for herpes zoster among patients who received the vaccine was 0.61.

Based on these results, the authors conclude that the herpes zoster vaccine may not, after all, increase the risk of herpes zoster or varicella and may decrease the overall risk in these patients. No significant safety issues were identified.

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