Recombinant Zoster Vaccine Uptake and Risk of Flares Among Older Adults With Immune‐Mediated Inflammatory Diseases in the US

Abstract

Objective Persons with immune‐mediated inflammatory diseases (IMIDs) are at an increased risk of herpes zoster (HZ). In 2018, the Centers for Disease Control and Prevention recommended a highly efficacious vaccine, recombinant zoster vaccine (RZV), for prevention of HZ in immunocompetent patients ≥50 years of age. This study was undertaken to estimate RZV vaccination among adults ages ≥50 years with IMIDs during 2018–2019 and to examine possible vaccine‐related flares following RZV. Methods We identified a cohort of IMID patients using medical claims data from the IBM MarketScan (ages 50–64 years) and Centers for Medicare and Medicaid Services Medicare (ages ≥65 years) databases. Presumed flares were defined as hospitalization/emergency department visit for their respective IMIDs, or steroid treatment with a short‐acting oral glucocorticoid or parenteral glucocorticoid injection. We conducted a self‐controlled case series (SCCS) analysis to examine a temporal association between RZV and flares. Results Among enrollees with IMIDs, 14.8% of 55,654 MarketScan enrollees and 43.2% of 160,545 Medicare enrollees received ≥1 dose of RZV in 2018–2019. Two‐dose series completion rates were 76.6% in MarketScan enrollees and 85.4% in Medicare enrollees. In the SCCS analysis, 10% and 13% developed flares in the control window, compared to 9% and 11–12% in the risk window following 1 or 2 doses of RZV among MarketScan and Medicare enrollees, respectively. We found no statistically significant increase in flares following RZV administration for any IMID in either age group following RZV dose 1 or dose 2. Conclusion We did not find an increase in presumed flares following RZV vaccination. Among adults ages ≥50 years with IMIDs, a substantial proportion received RZV compared to general zoster coverage estimates, and series completion rates were high.

EULAR recommendations for the management of systemic lupus erythematosus: 2023 update

“…In view of the COVID-19 pandemic and the burden of herpes zoster in patients with lupus,103 the current SLR included a research question regarding the efficacy and safety of vaccines against SARS-CoV-2 and herpes zoster virus (HZV) in lupus. Both the live attenuated and the more efficacious recombinant zoster vaccine have been used in patients with SLE and, although studies are limited, they are considered safe 104 105. Similarly, several observational studies have proven the immunogenicity and safety of SARS-CoV-2 vaccines, which are recommended for patients with SLE 106.…”

Risk of herpes zoster associated with JAK inhibitors in immune-mediated inflammatory diseases: a systematic review and network meta-analysis

“…In general populations, various risk factors such as increasing age, female gender, ethnicity of Asia and Oceania, substance abuse such as smoking or alcohol, genetic predisposition, psychological stress, and exposure to immunotoxins can collectively contribute to the elevated susceptibility to herpes zoster ( Thomas and Hall, 2004 ; van Oorschot et al, 2021 ; Curran et al, 2022 ; Kawahira et al, 2023 ). The pre-existing IMIDs themselves are also associated with an increased risk of herpes zoster ( Leung et al, 2022 ), and the use of JAK inhibitors can further increase the risk of herpes zoster in these patients ( Clarke et al, 2021 ). We have reason to believe that the combination of these factors may lead to an even higher incidence of herpes zoster infection.…”

Vaccination updates and special considerations for systemic lupus erythematosus patients

“…Thus far, there are no prospective trials evaluating the safety and efficacy of the herpes zoster subunit vaccine in SLE patients. However, in a broad retrospective study of patients with autoimmune diseases including SLE, no significant difference in disease flare following herpes zoster subunit vaccine was observed [72 ▪ ]. Other retrospective studies of herpes zoster subunit vaccine that included SLE patients have shown mild flares [73,74].…”