Researchers Assess Shingles Vaccination Status Among Veterans on Immunosuppressive Medications

Limited research has been conducted regarding the vaccination status of the recombinant zoster vaccine (RZV) in adults who are immunocompromised and 50 years of age or younger. New study findings assessed RZV immunization among this high-risk patient population, in veterans receiving immunocompromised medications within the Veteran Health Administration (VHA) health care system.¹

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Herpes zoster (HZ), commonly known as shingles, occurs following the reactivation of the varicella zoster virus (VZV). The virus can reoccur among individuals that previously had VZN, typically appearing as chickenpox, which reactivates as shingles. Individuals with shingles can experience a painful rash in dermatomal distribution which can continue for several weeks.²

The FDA approved RZV in 2021 for adults aged 18 years and older who are immunocompromised, following its original indication in 2017.³ Following the approval, the CDC and American College of Rheumatology issued an updated guidance for shingles vaccination.¹

The researchers conducted a cross-sectional study that was approved by the VA Quality Enhancement Research Initiative. The study authors used nationwide VHA data from 130 medical facilities that prescribed 1 or more immunosuppressive medications to a veteran for 90 days or more from January 1, 2018, to June 30, 2023. The data included the percentage of veterans that received 1 or more RZV doses during the study period, assessed before the expanded indication from January 2018 to February 2022, and anytime in the entire duration of the study.¹

The researchers conducted a multilevel regression model, which included age, sex, self-identified race and ethnicity, rurality of residence, visits with more than 1 subspecialty, receipt of 1 or more other vaccines at the VA, and immunosuppressive medication type. The study authors noted that a total of 190,162 veterans were reported to receive immunosuppressive medications across 130 facilities over the course of the study. However, at the end of the study, 23,295 veterans were younger than 50 years of age.¹

The results demonstrated that among veterans 50 years and older, 55,546 out of 153,620 individuals received RZV before the expanded indication and 83,117 out of 166,967 received it by mid-2023. Additionally, among veterans younger than 50 years, 638 out of 22,631 received a RZV vaccine before the expanded indication and 3118 out of 23,295 individuals had it by mid-2023.¹

“Demographic factors associated with lower odds of vaccination included male sex, African American and unknown race, and nonurban residence. Factors associated with increased odds of vaccination included treatment with tsDMARDs and other measures of increased health care use,” the study authors said in a news release.¹

The findings suggest that less than half of veterans in the US who take chronic immunosuppressive medications received even 1 dose of RZV and the data were even lower among those younger than 50 years, despite being at increased risk of shingles and associated complications.¹ The results emphasize the need for pharmacists and health care providers to further educate patients on receiving recommended immunizations.

REFERENCES

1. Recombinant Zoster Vaccination Among US Veterans Receiving Immunosuppressive Medications. JAMA Network Open. News release. October 11, 2024. Accessed October 18, 2024. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2824694?resultClick=3.

2. Ferruggia K. Study: Risk Factors Associated With Developing Ocular Complications Following Shingles Diagnosis. Pharmacy Times. News release. October 11, 2024. Accessed October 18, 2024. https://www.pharmacytimes.com/view/study-risk-factors-associated-with-developing-ocular-complications-following-shingles-diagnosis.

3. Ferruggia K. Study: Shingles Reactivation Could Occur in Rare Cases Following RZV. Pharmacy Times. News release. September 20, 2024. Accessed October 18, 2024. https://www.pharmacytimes.com/view/study-shingles-reactivation-could-occur-in-rare-cases-following-rzv.