Association between Vaccination for Herpes Zoster and Risk of Herpes Zoster Infection among Older Patients with Selected Immune-Mediated Diseases

Jie Zhang, Fenglong Xie, Elizabeth Delzell, Lang Chen, Kevin Winthrop, James D. Lewis, Kenneth G. Saag, John W. Baddley, Jeffrey R. Curtis

Research output: Contribution to journalArticle

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Abstract

Context: Based on limited data, the live attenuated herpes zoster (HZ) vaccine is contraindicated in patients taking anti-tumor necrosis factor (anti-TNF) therapies or other biologics commonly used to treat immune-mediated diseases. The safety and effectiveness of the vaccine are unclear for these patients. Objective: To examine the association between HZ vaccination and HZ incidence within and beyond 42 days after vaccination in patients with selected immune-mediated diseases and in relation to biologics and other therapies used to treat these conditions. Design, Setting, and Patients: Retrospective cohort study of 463 541 Medicare beneficiaries 60 years and older with rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, or inflammatory bowel disease using Medicare claims data from January 1, 2006, through December 31, 2009. Main Outcome Measures: Herpes zoster incidence rate within 42 days after vaccination (a safety concern) and beyond 42 days; hazard ratios estimated using Cox proportional hazards models for HZ comparing vaccinated vs unvaccinated patients. Results: Median duration of follow-up was 2.0 years (interquartile range, 0.8-3.0); 4.0% of patients received HZ vaccine. The overall crude HZ incidence rate was 7.8 cases per 1000 person-years (95% CI, 3.7-16.5) within 42 days after vaccination. The rate among the unvaccinated was 11.6 cases per 1000 person-years (95% CI, 11.4-11.9). Among 633 patients exposed to biologics at the time of vaccination or within the subsequent 42 days, no case of HZ or varicella occurred. After multivariable adjustment, HZ vaccination was associated with a hazard ratio of 0.61 (95% CI, 0.52-0.71) for HZ risk after 42 days. Conclusions: Receipt of HZ vaccine was not associated with a short-term increase in HZ incidence among Medicare beneficiaries with selected immune-mediated diseases, including those exposed to biologics. The vaccine was associated with a lower HZ incidence over a median of 2 years of follow-up.

Original languageEnglish (US)
Pages (from-to)43-49
Number of pages7
JournalJAMA - Journal of the American Medical Association
Volume308
Issue number1
DOIs
StatePublished - Jul 4 2012

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Immune System Diseases
Herpes Zoster
Vaccination
Infection
Herpes Zoster Vaccine
Medicare
Biological Products
Incidence
Vaccines
Safety
Psoriatic Arthritis
Biological Therapy
Chickenpox
Ankylosing Spondylitis
Inflammatory Bowel Diseases
Psoriasis
Proportional Hazards Models
Rheumatoid Arthritis
Cohort Studies
Retrospective Studies

ASJC Scopus subject areas

  • Medicine(all)

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Association between Vaccination for Herpes Zoster and Risk of Herpes Zoster Infection among Older Patients with Selected Immune-Mediated Diseases. / Zhang, Jie; Xie, Fenglong; Delzell, Elizabeth; Chen, Lang; Winthrop, Kevin; Lewis, James D.; Saag, Kenneth G.; Baddley, John W.; Curtis, Jeffrey R.

In: JAMA - Journal of the American Medical Association, Vol. 308, No. 1, 04.07.2012, p. 43-49.

Research output: Contribution to journalArticle

Zhang, Jie ; Xie, Fenglong ; Delzell, Elizabeth ; Chen, Lang ; Winthrop, Kevin ; Lewis, James D. ; Saag, Kenneth G. ; Baddley, John W. ; Curtis, Jeffrey R. / Association between Vaccination for Herpes Zoster and Risk of Herpes Zoster Infection among Older Patients with Selected Immune-Mediated Diseases. In: JAMA - Journal of the American Medical Association. 2012 ; Vol. 308, No. 1. pp. 43-49.
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abstract = "Context: Based on limited data, the live attenuated herpes zoster (HZ) vaccine is contraindicated in patients taking anti-tumor necrosis factor (anti-TNF) therapies or other biologics commonly used to treat immune-mediated diseases. The safety and effectiveness of the vaccine are unclear for these patients. Objective: To examine the association between HZ vaccination and HZ incidence within and beyond 42 days after vaccination in patients with selected immune-mediated diseases and in relation to biologics and other therapies used to treat these conditions. Design, Setting, and Patients: Retrospective cohort study of 463 541 Medicare beneficiaries 60 years and older with rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, or inflammatory bowel disease using Medicare claims data from January 1, 2006, through December 31, 2009. Main Outcome Measures: Herpes zoster incidence rate within 42 days after vaccination (a safety concern) and beyond 42 days; hazard ratios estimated using Cox proportional hazards models for HZ comparing vaccinated vs unvaccinated patients. Results: Median duration of follow-up was 2.0 years (interquartile range, 0.8-3.0); 4.0{\%} of patients received HZ vaccine. The overall crude HZ incidence rate was 7.8 cases per 1000 person-years (95{\%} CI, 3.7-16.5) within 42 days after vaccination. The rate among the unvaccinated was 11.6 cases per 1000 person-years (95{\%} CI, 11.4-11.9). Among 633 patients exposed to biologics at the time of vaccination or within the subsequent 42 days, no case of HZ or varicella occurred. After multivariable adjustment, HZ vaccination was associated with a hazard ratio of 0.61 (95{\%} CI, 0.52-0.71) for HZ risk after 42 days. Conclusions: Receipt of HZ vaccine was not associated with a short-term increase in HZ incidence among Medicare beneficiaries with selected immune-mediated diseases, including those exposed to biologics. The vaccine was associated with a lower HZ incidence over a median of 2 years of follow-up.",
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AU - Xie, Fenglong

AU - Delzell, Elizabeth

AU - Chen, Lang

AU - Winthrop, Kevin

AU - Lewis, James D.

AU - Saag, Kenneth G.

AU - Baddley, John W.

AU - Curtis, Jeffrey R.

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