Archive for October 23, 2015

Vaccination against zoster remains effective in older adults who later undergo chemotherapy.

Clin Infect Dis. 2014 Oct;59(7):913-9.

Tseng HF1, Tartof S1, Harpaz R2, Luo Y1, Sy LS1, Hetcher RC1, Jacobsen SJ1.

Author information

1Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.

2Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

Abstract

BACKGROUND:

Approximately 40% of adults develop invasive cancer during their lifetimes, many of whom require chemotherapy. Herpes zoster (HZ) is common and often severe in patients undergoing chemotherapy, yet there are no data regarding whether these patients retain specific protection against HZ if they had previously received zoster vaccine. We conducted a study to determine whether zoster vaccine was effective in patients who subsequently underwent chemotherapy.

METHODS:

The cohort study consisted of Kaiser Permanente Southern California members aged ≥60 years treated with chemotherapy. The exposure variable was receipt of zoster vaccine prior to initiation of chemotherapy. Incident HZ cases were identified using International Classification of Diseases, Ninth Revision diagnostic codes. HZ incidence rates were calculated; hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression models.

RESULTS:

There were 91 and 583 HZ cases in the vaccinated and unvaccinated cohorts, respectively, yielding an incidence rate of 12.87 (95% CI, 10.48-15.80) vs 22.05 (95% CI, 20.33-23.92) per 1000 person-years. Thirty-month cumulative incidence was 3.28% in the vaccinated group and 5.34% in the unvaccinated group (P < .05). The adjusted HR for HZ was 0.58 (95% CI, .46-.73) and showed no significant variation by age, sex, or race. HZ incidence rates remained increased in the small subgroup of persons receiving zoster vaccine within 60 days before chemotherapy, but this was the only group affected by indication bias. No vaccinated patients underwent hospitalization for HZ, compared with 6 unvaccinated patients.

CONCLUSIONS:

Zoster vaccine continues to protect against HZ if recipients later undergo chemotherapy. Our findings provide an additional rationale for offering zoster vaccine to indicated adults while they are immunocompetent.

PDF

http://cid.oxfordjournals.org/content/59/7/913.full.pdf

 

 

Clin Infect Dis. 2014 Oct;59(7):920-2.

Editorial commentary

Zoster vaccine in immunocompromised patients – Time to reconsider current recommendations.

Oxman MN1, Schmader KE2.

Author information

1Infectious Diseases Section, Medicine Service, Veterans Affairs San Diego Healthcare System Division of Infectious Diseases, University of California San Diego School of Medicine.

2Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center Department of Medicine, Duke University, Durham, North Carolina.

PDF

http://cid.oxfordjournals.org/content/59/7/920.full.pdf

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October 23, 2015 at 2:49 pm

Update on herpes zoster vaccination: a family practitioner’s guide.

Can Fam Physician. 2011 Oct;57(10):1127-31.

Clinical Review

Shapiro M1, Kvern B, Watson P, Guenther L, McElhaney J, McGeer A.

Author information

1Department of Family and Community Medicine, University of Toronto, ON, Canada. MarlaMD@aol.com

Abstract

OBJECTIVE:

To answer frequently asked questions surrounding the use of the new herpes zoster (HZ) vaccine.

SOURCES OF INFORMATION:

Published results of clinical trials and other studies, recommendations from the Canadian National Advisory Committee on Immunization, and the US Advisory Committee on Immunization Practices; data were also obtained from the vaccine’s Health Canada-approved product monograph.

MAIN MESSAGE:

Herpes zoster results from reactivation of the varicella-zoster virus; postherpetic neuralgia (PHN) is its most common and serious complication. The incidence of PHN after HZ is directly related to age, with 50% of affected individuals older than 60 years experiencing persistent and unrelieved pain. The live virus HZ vaccine reduces the incidence of HZ by about 50% and the occurrence of PHN by two-thirds, with vaccinated individuals experiencing attenuated or shortened symptoms. The vaccine is contraindicated in many immunocompromised patients and might not be effective in patients taking antiviral medications active against the HZ virus. Physicians should be aware of the different recommendations for these groups.

CONCLUSION:

The HZ vaccine is a safe and effective preventive measure for reducing the overall burden and severity of HZ in older adults. The vaccine appears to be cost-effective when administered to adults aged 60 years and older

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192074/pdf/0571127.pdf

October 23, 2015 at 2:47 pm

Vaccinations for rheumatoid arthritis.

Curr Rheumatol Rep. 2014 Aug;16(8):431.

Perry LM1, Winthrop KL, Curtis JR.

Author information

1Division of Arthritis & Rheumatic Diseases, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.

Abstract

Patients with rheumatoid arthritis (RA) suffer an increased burden of infectious disease-related morbidity and mortality and have twice the risk of acquiring a severe infection compared to the general population.

This increased risk is not only a result of the autoimmune disease but is also attributed to the immunosuppressive therapies that are commonly used in this patient population.

Given the increase in infection-related risks in RA, there is great interest in mitigating such risk. A number of vaccines are available to the rheumatologist, with a handful that are of importance for RA patients in the United States.

The goal of this paper is to highlight the most recent literature on the key vaccines and the specific considerations for the rheumatologist and their RA patients, with a particular focus on influenza, pneumococcal, and herpes zoster vaccines.

It is important for rheumatologist to understand and be aware of which vaccines are live and what potential contraindications exist for giving vaccines to RA patients.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080407/pdf/nihms-604880.pdf

October 23, 2015 at 2:44 pm


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