Q:

11/15/2013
Is it OK to give herpes zoster vaccine in patient with decreased immunoglobulins? Pt has bronchial asthma; has appropriate response to pneumococcal and tetanus.

A:

Thank you for your inquiry.

Unfortunately, I am not going to be able to give you a definitive answer to your question, but I can share with you an opinion.

As you know, zoster vaccine, according to the package insert, is contraindicated in a patient who is immunosuppressed.

It is obvious that this is a broad and somewhat generic warning, and does not specify the degree of immune suppression nor the type of immunosuppression. On the other hand, there is an encouraging quote from an article from the Cleveland Clinic which states that the administration of Zostavax is safe in patients with isolated humoral immunodeficiency. This of course is based on the fact that the immune defense against zoster is cell-mediated since the organism is basically intracellular. Thus, in my opinion, in your patient who exhibits no clinical evidence of immune deficiency (at least that you have mentioned), it would be reasonably safe to administer zoster vaccine. However, you did not mention the reason for ordering immunoglobulins in the first place, and this opinion of course would be based on the lack of any evidence of a clinically evident immunodeficiency such as common variable immunodeficiency (in which a T cell deficiency may be present) in your patient

"Although zoster vaccine is contraindicated in conditions of cellular immune deficiency, patients with humoral immunodeficiency (eg, hypogammaglobulinemia or dysgammaglobulinemia) can receive it.(10.3949/ccjm.75a.08046 Cleveland Clinic Journal of Medicine January 2009 vol. 76 1 45-48)"

Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.
 

AAAAI - American Academy of Allergy Asthma & Immunology