Shingles Risk Slashed in IBD Patients After Vaccine

Risk of herpes zoster infection among older adults with inflammatory bowel disease (IBD) decreased more than twofold after receiving the recombinant zoster vaccine (RZV; Shingrix), regardless of steroid use, a retrospective VA study found.

Following full-dose RZV, the crude herpes zoster incidence rate was reduced from 3.93 to 0.00 per 1,000 person-years among veterans ages 50 to 60, and from 4.57 to 1.80 per 1,000 person-years for those over 60 years, reported Nabeel Khan, MD, of the Corporal Michael J. Crescenz VA Medical Center in Philadelphia, and colleagues in Clinical Gastroenterology and Hepatology.

After multivariate adjustment, RZV was significantly associated with lower risk of herpes zoster infection in both groups versus no vaccination:

• 50 to 60: HR 0.00 (P<0.001)
• 60 and older: HR 0.39 (P=0.01)

“Previous literature has suggested that the risk of herpes zoster is 1.2-1.8 times higher in the IBD group compared to the general population, with higher risks among patients using thiopurines, a combination of anti-TNF [tumor necrosis factor] and thiopurines, and corticosteroids within the previous 30 days,” wrote Khan and co-authors.

In the current study, hazard ratios for patients on IBD medications or steroids were consistent with a lower herpes zoster risk associated with full-dose RZV vaccination, although the analyses were limited by the small numbers of events.

Lowest incidence occurred in veterans who were fully vaccinated on IBD medications — anti-TNF agents, vedolizumab (Entyvio), ustekinumab (Stelara), and tofacitinib (Xeljanz) — with no case reported. Unvaccinated veterans also experienced lower herpes zoster incidence rates with these medications.

The American College of Gastroenterology urges all IBD patients — especially those over age 50 — to receive RZV, and the CDC recommends RZV for immunocompetent adults 50 and over, but there have not been any previous trials to assess the efficacy of RZV among immunosuppressed patients, including those with IBD.

For their study, the researchers studied more than 33,000 patients diagnosed with IBD before Jan. 3, 2018 from the national Veterans Affairs Healthcare System. Follow-up occurred at 60-day intervals as well as at herpes zoster diagnosis, death, or at the end of the study on Oct. 31, 2020. Participants were divided into two age groups, those ages 50 to 60 (n=7,008), and those over 60 (n=26,292).

Over 70% of participants were white, and most were older and had comorbidities. More patients in each group had ulcerative colitis than Crohn’s disease.

After a single dose, the herpes zoster event rate dropped from 3.93 to 1.79 per 1,000 person-years for the 50 to 60 age group and from 4.57 to 2.48 per 1,000 person-years for those over 60, which was not significantly better than no vaccination.

“Our analysis according to vaccine dose suggested that receiving a single RZV dose may impart some level of protection against HZ [herpes zoster] among IBD patients,” the authors wrote. “However, this level of protection appeared to be lower than that achievable with full-dose RZV. These results underscore the importance of compliance with full-dose RZV vaccination.”

Vaccination rates among veterans ages 50 to 60 was 10.9% and among those over 60 was 20.5%. “This highlights that more efforts need to be made to efficiently utilize various tools in the electronic medical records system such as reminders to increase the vaccination rates,” the authors stated.

Limitations of the study included that the vast majority of participants were men (over 82%) and the results may not be generalizable to “non-veteran” populations. Also, the number of reported herpes zoster events was low for the general analysis, though cases could have been underreported.