Many patients in dermatology have immunosuppressive diseases or are receiving immunosuppressive indications, such as biologics, which are considered a contraindication for the live varicella zoster vaccine.
Findings from a recent study showed that the live varicella zoster vaccine may be safe among immunosuppressed patients, especially those with mild suppression. According to the authors, there was no evidence that showed the live vaccine was associated with severe consequences, such as hospitalization.
It is important to understand the safety of live vaccination during immunosuppression in order to support guidance on use of the vaccine and to ensure that individuals who can safely benefit from the vaccine are enabled to do so, the researchers said.
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Using anonymized data from the Clinical Practice Research Datalink (CPRD), they identified 168,767 individuals who were age-eligible for varicella zoster vaccination from September 1, 2013 through August 31, 2017. The main outcomes included immunosuppressive, zoster vaccination, diagnoses of specific varicella-zoster virus (VZV)-related disease and non-specific rash/encephalitis compatible with VZV-related disease.
The researchers identified a period of immunosuppressive among 9093 out of 168,767 individuals (5.4%). The overall vaccination rate while immunosuppressed was 1742 out of 5251, they said.
Among the 1742 individuals who were inadvertently vaccinated while immunosuppressed, the researchers only identified 2 cases of VZV-related disease within 8 weeks of vaccination (0.1%; 95% CI, 0.01%-0.04%). Both cases were diagnosed in a primary care setting and did not have a related hospital admission, they observed.
When using a broader definition that included non-specific rash or encephalitis, the researchers identified an additional 23 possible cases; however, there were no instances of encephalitis. In addition, all 25 cases were diagnosed in a primary care setting and none had related hospital admissions, they noted.
“These findings support a review of the extent to which live zoster vaccination is contraindicated among the immunosuppressed,” the researchers concluded.
Furthermore, “this should reassure [practitioners] and encourage vaccination of mildly immunosuppressed individuals who do not meet current thresholds for contraindication,” they added.
Grint DJ, McDonald HI, Walker JL, et al. Safety of inadvertent administration of live zoster vaccine to immunosuppressed individuals in a UK-based observational cohort analysis. BMJ Open. 2020;10:e034886. doi:10.1136/bmjopen-2019-034886