Shingles Vaccine Contraindicated in Patients at Greatest Risk

According to the results of a recent study, the patients at the highest risk for shingles are those with immunosuppressive conditions that make them ineligible to receive the shingles vaccine.

The study, published online on May 13, 2014, in BMJ, compared over 144,000 shingles patients with a control group of individuals without shingles to determine whether certain medical conditions were risk factors for developing the disease.

The research team found that patients with rheumatoid arthritis, inflammatory bowel disease, or chronic obstructive pulmonary disease were 27% to 44% more likely to develop shingles than patients without those diseases; patients with asthma, chronic kidney disease, depression, and diabetes were also found to be at higher risk.

The researchers concluded that the strongest risk factors associated with shingles were diseases that caused severe immunosuppression; for example, patients with leukemia were twice as likely to develop shingles as individuals without it, while patients with HIV were almost 5 times as likely to do so. The shingles vaccine is currently contraindicated in patients with such conditions, leading the authors to emphasize the need for alternate strategies to reduce the risk for shingles in these patients.

“What this study has highlighted, however, is that the strongest clinical risk factors for zoster are contraindications to its vaccine; the people arguably in most need of protection against zoster cannot currently benefit from vaccination,” wrote the study’s authors. “Alternative risk reduction strategies in these patients would help those at greatest risk of this disease and its complications.”