- Fecal Incontinence
Most eligible IBD patients don't get shingles vaccine
Last Updated: 2018-07-23
By Anne Harding
NEW YORK (Reuters Health) - Just one in five patients with inflammatory bowel disease (IBD) who are eligible for the herpes zoster (HZ) vaccine actually receive it, according to new study in VA patients.
"The rates are very low and especially low among people who need it the most," Dr. Nabeel Khan of the University of Pennsylvania Perelman School of Medicine in Philadelphia, the study's first author, told Reuters Health in a telephone interview.
People with IBD are more prone to HZ infection, while being on immunomodulators further increases risk. The likelihood of developing shingles climbs with aging, and can reach 2% a year for older IBD patients on immunosuppressants, Dr. Khan and his team note in their July 5 report in Inflammatory Bowel Diseases.
The American College of Gastroenterology (ACG) recommends HZ vaccination for all IBD patients over 50, while European Crohn's and Colitis Organization and Advisory Committee on Immunization Practices guidelines call for the shingles vaccine in IBD patients 60 and older.
To investigate HZ vaccine coverage, Dr. Khan and his colleagues looked at 18,825 IBD patients in the Veterans Affairs Healthcare system who had reached age 60 as of 2008, two years after the US Food and Drug Administration licensed Merck & Co, Inc.'s Zostavax. The FDA approved another HZ vaccine, GlaxoSmithKline's Shingrix, in October 2017.
Overall, 3,946 (20.96%) had been immunized against HZ at some point during follow-up. In the first five years of follow up, 11.7% of the group had been vaccinated.
Patients with ulcerative colitis were more likely to have received the vaccine than Crohn's disease patients, Dr. Khan and his team found. Patients on steroids, thiopurines or anti-TNF agents were less likely to be vaccinated against HV, as were older patients and those with worse comorbidities. Vaccination rates were lower among African Americans compared to whites. Coverage was also lower in nine states the authors referred to as the Continental district, which includes Montana, Texas, Arkansas, Louisiana, Mississippi and other southern and mountain states. Just 12.5% of IBD patients in this region had received the HZ vaccine, compared to 29.4% for the North Atlantic region.
HZ causes a painful rash, with complications that can include postherpetic neuralgia and other neurologic and ocular effects. "It is a bad disease to have, in a population that is at increased risk for the disease, so hopefully physicians will pay more attention to vaccines for this preventable thing in this susceptible population," Dr. Khan said.
He and his colleagues are working on a plan for increasing HZ vaccination rates among IBD patients that they plan to implement throughout their network.
Dr. Khan has received research support from Pfizer, Luitpold and Takeda Pharmaceuticals, while other study authors also disclose financial support from pharmaceutical companies, including Merck.
Inflamm Bowel Dis 2018.