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In Autoimmune Patients, Shingles Vaccine Seen as Effective for 5 Years
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In patients with autoimmune disease, the effectiveness of the herpes zoster vaccine appears to be attenuated after about 5 years, according to recently published findings.
In the retrospective cohort study, researchers reviewed Medicare data from 2006 to 2013 on all patients with autoimmune diseases, including rheumatoid arthritis, ankylosing spondylitis inflammatory bowel disease, psoriasis, and psoriatic arthritis. Using CPT code 90736 or National Drug Codes (NDC), researchers identified 59,627 patients who had been vaccinated against herpes zoster (HZ). Patients were deemed eligible if they had at least 12-months continuous Medicare fee-for-service coverage prior to vaccination and throughout follow-up. Also analyzed was an unvaccinated cohort (n=119, 254) matched 1:2 for age, sex, race, disease, use of biologics, disease-modifying antirheumatic drugs and glucocorticoids. The mean age in both groups was 73.5 years.
Follow-up began from 30 days after the vaccination date or corresponding calendar date in unvaccinated patients, and ended at whichever of the following events occurred first: first HZ, death, loss of coverage or Dec. 31, 2013. The primary outcome was first HZ event during follow-up. Researchers used Poisson regression to calculate incidence rates (IR) and adjusted risk ratios of HZ each year post-vaccination.
Researchers found that in the vaccinated group, there was an increase from 0.75 per 100 person-years (PY) in the first year after vaccination to 1.25 in the seventh year after vaccination. Conversely, the unvaccinated group maintained a relatively consistent incident rate of HZ (1.3 to 1.7/100 PY) between the first and seventh year of follow-up. Adjustment for matched carriable and potential confounders revealed a significantly lower risk of HZ in vaccinated patients vs. unvaccinated during the 5 years. Between years 3 and 5, the risk ratio for HZ ranged from 0.74 to 0.77. This protective effect in the vaccinated group ceased to be significant during the sixth and seventh years post-vaccination.
“The key findings of the study were that in patients with inflammatory diseases like rheumatoid arthritis, the significant protection conferred by the vaccine lasted only up to 5 years,” study researcher Jeffrey R. Curtis, MD, of the University of Alabama at Birmingham, told Healio Rheumatology. “Re-vaccinating patients thus might be considered at that time.”– by Jennifer Byrne
Disclosure: The researchers report no relevant disclosures.
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