Shingrix Is Highly Effective for Patients With IBD

According to results from a new study on the effect of Shingrix in individuals with inflammatory bowel disease (IBD), the recombinant zoster vaccine (RZV) is associated with a decreased risk of shingles infection among the 2 age groups studied.¹

The authors of the retrospective cohort study, which was conducted in the Veterans Affairs (VA) health care system, noted that individuals with IBD are at an increased risk of herpes zoster (HZ) infection. Their greater susceptibility to the varicella zoster virus, which causes shingles, is linked to the immunosuppressive treatments they receive for their disease.

The study investigators acknowledged that although the efficacy of the Shingrix vaccine has been proved to be high among immunocompetent individuals, little was known about its effect among immunosuppressed individuals with IBD.

“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 lead author Nabeel Khan, MD, of the Department of Gastroenterology at Corporal Michael J. Crescenz VA Medical Center in Philadelphia.

The study involved patients who had received an IBD diagnosis on or before January 3, 2018, the earliest date the RZV was administered. The investigators collected data on 2 groups of eligible patients: 7008 in the 50- to 60-years group and 26,292 in the over-60-years group.

“We identified veterans who received RZV and compared the incidence of HZ between vaccinated vs unvaccinated individuals,” the authors wrote. “We performed multivariable Cox regression with time varying analysis to determine the risk of HZ among the vaccinated (full dose and single dose separately) vs unvaccinated cohort, stratified by IBD medications.”

They reported that compared with the unvaccinated group the crude HZ incidence rate after a full-dose vaccination of RZV was lower in both the 50- to 60-years group (0.00 vs 3.93 per 1000 person-years) and the over-60-years group (1.80 vs 4.57 per 1000 person-years).

Shingrix vaccination was associated with a significantly lower risk of HZ among those aged 50 to 60 years and among those older than 60 years, although the finding was limited by low HZ event rates. The authors concluded that greater efforts should be made to vaccinate all patients with IBD with Shingrix, the only shingles vaccine available in the United States.

According to the CDC, the majority of the 3 million adults in the United States with IBD received their diagnosis in their 20s and 30s, decades before reaching the current age requirement of 50 for receiving Shingrix.² The agency recommends Shingrix for the prevention of shingles and related complications in adults 50 years and older, particularly for individuals with chronic medical conditions, unless a contraindication or precaution exists.³

The Crohn’s & Colitis Foundation reports that as many as 70,000 new cases of IBD are diagnosed in the United States annually.⁴ Further, there may be as many as 80,000 children in the country with IBD. All these individuals are at a potentially greater risk for developing shingles, which could be prevented through vaccination.

References

1. Khan N, Wang L, Trivedi C, et al. Efficacy of recombinant zoster vaccines in patients with inflammatory bowel disease.
2. Inflammatory Bowel Disease (IBD) in the United States. Centers for Disease Control and Prevention. Accessed August 1, 2021. https://www.cdc.gov/ibd/data-statistics.htm.
3. Shingrix Recommendations. Centers for Disease Control and Prevention. Accessed August 1, 2021. https://www.cdc.gov/vaccines/vpd/shingles/hcp/shingrix/recommendations.html.
4. The Facts About Inflammatory Diseases. Crohn’s & Colitis Foundation of America. November 2014. Accessed August 1, 2021. https://www.crohnscolitisfoundation.org/sites/default/files/2019-02/Updated%20IBD%20Factbook.pdf.