Herpes Zoster, or Shingles, is a painful reactivation of the Varicella virus, which hides in the dorsal nerve roots of patients previously infected with chicken pox. It is estimated that 1 in 3 adults will develop it in his/her lifetime, especially when one gets older or become immunosuppressed.
Vaccination, acting like a booster for those previously exposed, is therefore advised for those above 60, and above 50 if on immunosuppressants. Each dose, or actually getting Shingles, is protective for about 5 years.
Unfortunately, it is a live vaccine. Ideally, strong immunosuppressants like biologics and high dose steroids should be stopped for 5 half-lives of the drug before vaccination (to avoid live albeit weakened virus running rogue), and resumed no earlier than 2-3 weeks thereafter (to allow for adequate immunization). However, patients with very active diseases may not be able to sit out this “drug-free” duration.
Tofacitinib use is associated with Shingles reactivation, making vaccination advisable. This study addresses the concern of the vaccine’s efficacy despite resuming Tofacitinib 2-3 weeks after vaccination.
In patients with very active arthritis, it is not easy to interrupt needed treatment for long just to get the live Zoster vaccine. It is therefore heartening to know that not one of 633 patients who “inadvertently” received the vaccine while still on biologics developed Shingles (read the JAMA paper referenced in the article).
But this does not give licence for rheumatologists to administer Zostavax while their patients are still on biologics or Tofacitinib. Conveniently, most local rheumatologists do not carry vaccines. Patients may “inadvertently” saunter to the primary care facilities to get vaccinated😉
Pneumovax Falls Short in Lupus
