Risk of Herpes Zoster in Autoimmune and Inflammatory Diseases: Implications for Vaccination

Abstract

Objective. The herpes zoster (HZ) vaccine is recommended for adults in the US ages ‡60 years who do not have weakened immune systems. It is unclear how the risk of HZ varies according to age and disease conditions in younger patients with autoimmune or inflammatory (AI) diseases. This study was undertaken to evaluate the age-stratified incidence of HZ in patients with AI diseases as compared to older adults for whom the HZ vaccine is currently recommended by the US Centers for Disease Control and Prevention.Methods. Using linked data obtained from patients who were insured by US commercial and government health care plans during the period 2007-2010, 7 cohorts of patients with AI diseases were assembled: systemic lupus erythematosus (SLE), inflammatory bowel disease (IBD), rheumatoid arthritis (RA), psoriatic arthritis (PsA), psoriasis (PsO), ankylosing spondylitis (AS), and gout. Two comparator cohorts were also assembled as controls: adult patients with diabetes and adult subjects without AI diseases or diabetic conditions. HZ was identified using diagnostic codes. Age-specific incidence rates (IRs) of HZ were calculated and compared to the IRs of HZ in control subjects ages 61-70 years who were without AI diseases or diabetic conditions.Results. After review of the linked data, the following number of enrollment periods were identified: 8,395 for patients with SLE, 7,916 for patients with IBD, 50,646 for patients with RA, 2,629 for patients with PsA, 4,299 for patients with PsO, 1,019 for patients with AS, 58,934 for patients with gout, 214,631 for control patients with diabetes, and 330,727 for control subjects without AI diseases and diabetic conditions. The respective highest and lowest IRs of HZ during the study were 19.9 per 1,000 person-years in the SLE cohort and 6.8 per 1,000 person-years in the gout cohort, as compared to an IR of 5.3 per 1,000 person-years in control subjects without AI diseases or diabetic conditions. The age-specific IRs of HZ in patients with RA and those with SLE ages ‡40 years were 1.5-2 times greater than those observed in

Longterm Effectiveness of Herpes Zoster Vaccine among Patients with Autoimmune and Inflammatory Diseases

“…In unvaccinated healthy older people in the SPS, the absolute IR was 1.1 per 100py in patients age 70 and older. Rates in our study were approximately 50% increased, consistent with prior observations that have found elevated rates of HZ in autoimmune disease patients (18). …”

Real-world comparative risks of herpes virus infections in tofacitinib and biologic-treated patients with rheumatoid arthritis

“…This is important because patients with RA already have an elevated HZ risk compared with the general population 4 5. HZ complications can cause significant morbidity, for example chronic, debilitating pain syndromes.…”

Gaps in Aging Research as it Applies to Rheumatologic Clinical Care

“…95 Additional literature is emerging suggesting that younger adults with autoimmune diseases or inflammatory conditions have rates of herpes zoster that are comparable to or greater than the rates in older adults and that this population should be considered for vaccination at a younger age cut off. 96 How this would impact our vaccination practices as patients with rheumatologic diseases age is unknown. Further research is needed in older adults with rheumatologic diseases and multimorbidity to determining vaccine efficacy and scheduling.…”