Herpes zoster vaccine may benefit younger people with rheumatoid arthritis, Lupus, inflammatory bowel disease

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

Systemic lupus erythematosus, also known as SLE or lupus, is a chronic disease with a wide variety of symptoms that include pain, swelling and inflammation. Lupus may affect the skin, joints, kidneys, lungs, nervous system and other organs of the body. Most patients feel fatigue and have rashes, arthritis (painful and swollen joints) and fever. Lupus affects 10 times as many women as men and often affects people in their 20s and 30s.

Herpes zoster (HZ) occurs in one out of three U.S. adults during their lifetimes. A primary risk factor is age. People with autoimmune, inflammatory diseases like RA are at as much as twofold increased risk of developing HZ due to their suppressed immune systems or taking medications like prednisone. HZ vaccination is recommended for adults 60 or over, but no evidence supports whether the risk of HZ infection in younger people may warrant vaccination.

Researchers at the University of Alabama, Birmingham, and Oregon Health and Science University in Portland evaluated data collected from the 2007-2010 Multi-Payer Claims Database to determine incidence of HZ in a younger population of patients with autoimmune, inflammatory diseases that may put them at increased risk for infection.

The researchers assembled seven cohorts of patients with autoimmune, inflammatory diseases cohorts, requiring the patients to have ≥ 13 months of continuous medical and pharmacy coverage. The cohorts included those patients with at least one prescription and two diagnoses of rheumatoid arthritis (RA), psoriasis arthritis (PsA), psoriasis (PsO), ankylosing spondylitis (AS), inflammatory bowel disease (IBD), lupus (SLE) and gout, and compared their infection rates with diabetic patients and healthy patients without diabetes or any autoimmune disease.

The study population included 50,646 RA patients, 2,629 PsA patients, 4,299 psoriasis patients, 1,019 AS patients, 7,916 IBD patients, 8,395 SLE patients, 5,893 gout patients, 214,631 diabetes patients and 330,727 healthy patients.

The age-adjusted incidence rates for HZ among the seven disease cohorts ranged from a high of 14.6 per 1,000 person years for those with SLE to a low of 5.0 for those with gout. Comparatively, the age-adjusted incidence rate of HZ was 5.9/1000 for people with diabetes and 3.9/1000 for people who were healthy. The age-specific rate of HZ for RA, SLE and IBD patients in their 20s, 30s and 40s, was either non-inferior or significantly greater than the corresponding rate in healthy people who were 60 or over.

The study's authors concluded that RA, SLE and IBD are associated with a higher incidence of HZ infection compared to healthy individuals. The findings led them to further conclude that people age 30 or over with RA, SLE and IBD may benefit from HZ vaccination.