Selective IgM deficiency and non-live viral vaccines
Question:
9/16/2019
I am seeing a 65 year-old female with selective IgM deficiency (IgM<7 with normal IgA and IgG) inquiring about shingles vaccine. Patient had only partial AB response to pneumococcal vaccine (actual pre and post lab values not in EMR). Lymphocyte enumeration and rest of immune evaluation was wnl. Patient has no history of frequent or severe infections. She is currently on hydroxychloroquine for sicca syndrome and occasionally on prednisone. From what I read, the hydroxychloroquine is not a contraindication for shingles immunization and maybe okay to consider shingles vaccine for patients with IgM deficiency?
Answer:
I will assume that this patient has been able to mount good protective immune responses to other protein vaccines. Given that the preferred vaccine, Shingrix (recombinant zoster vaccine), is not a live virus, there should be essentially no increased risk when given to your patient and a very large chance for benefit. The current immune suppression the patient is on for her SICCA syndrome may lessen the effectiveness of the vaccination, but it is possible to check for protective IgG antibody production to Herpes zoster after the vaccination to verify effective titers. If need a third dose could be considered.
I hope this information is of help to you and your patient.
Regards,
Eric Macy, MD, MS, FAAAAI