Q:

11/6/2013
The rheumatologists at our hospital have been asking our immunization section to give the shingles vaccine to all of their patients before they receive DMARDS or other biologic agents. They base this on their 2012 guidelines. They tell us this is a common practice in the rheum community. They give this vaccine regardless of age. We are uncomfortable giving this to patients younger than 50, especially those in their 20s who may have not been exposed to Chicken Pox. Your thoughts and guidance would be appreciated.

A:

Thank you for your inquiry.

Unfortunately, I am afraid that I cannot give you any evidence-based or consensus-based opinion regarding the recommendations of the American College of Rheumatology (ACR). To my knowledge, and according to a search of the literature, the Allergy-Immunology community has not systematically investigated this issue nor made any formal statement in this regard. Thus, any comment would simply be based upon an opinion created after reading the guidelines themselves. I have done this as well as looked at a brief summary, and I am afraid they do not allow any definitive opinion in this regard. Below is a link to what I believe is the original guidelines themselves which goes through a detailed discussion. After reading both, I am still afraid that I cannot give you a definitive answer. Therefore I think it would be helpful for you to read these guidelines yourself and discuss them with the rheumatologists. I do not think the issue that you mentioned is clearly delineated in these documents, but perhaps through your reading, you might be able to clarify it yourself.

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

Update on Herpes Zoster (Shingles) Vaccine for Autoimmune Disease Patients

Singh JA, et al. Summary of 2012 update of 2008 ACR recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care & Research 2012 (May); 64(5):625-639. DOI 10.1002/acr.21641

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology