Shingles Shot Contraindicated for Those Who Need It Most
By Anne Harding
NEW YORK - Several autoimmune conditions are associated with an increased risk of developing shingles, according to a new case-control study from the UK.
The greatest risk was seen among people with severely suppressed immune systems, such as myeloma and lymphoma patients, Dr. Harriet Forbes of the London School of Hygiene and Tropical Medicine and her colleagues found.
However, the live vaccine that reduces the risk of herpes zoster and post-herpetic neuralgia is contraindicated for patients with severe immune deficiency, the investigators note in their report, online May 13 in BMJ.
"Those at greatest risk of shingles can't get the vaccine," Dr. Forbes told Reuters Health. "There's not a great deal physicians can do for that at the moment."
To quantify the effects of potential risk factors for shingles among patients at different ages, Dr. Forbes and her team looked at data on nearly 145,000 UK adults diagnosed with the condition between 2000 and 2011 and some 549,000 controls matched by age, sex and practice.
Overall, the researchers found, a number of conditions were linked to an increased likelihood of shingles, including rheumatoid arthritis; inflammatory bowel disease; chronic obstructive pulmonary disease; asthma; chronic kidney disease; and depression; and type 1 diabetes. The effects associated with these conditions were stronger among younger patients.
People with severely suppressed immune systems were at the greatest risk. For example, lymphoma patients were at nearly four-fold increased risk versus those without lymphoma, and myeloma patients were at more than double risk.
In the U.S. and Australia, the herpes zoster vaccine is recommended for people 60 and older, while in the UK it is routinely available to 70-year-olds, with catch-up immunization available for patients in their 70s, Dr. Forbes and her team point out.
It's not clear, based on the findings, whether it would be cost-effective to offer the vaccine to younger patients with conditions that put them at increased risk of shingles, the investigator noted.
To answer this question, it will be important to understand whether these conditions also put patients at greater risk of post-herpetic neuralgia, added Dr. Forbes, who is currently studying this question.
SOURCE: https://bit.ly/1oYWDaK
BMJ 2014.
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