Use of Recombinant Zoster Vaccine (RZV-Shingrix) in Patients With Inflammatory Bowel Disease 712

• Published in: The American journal of gastroenterology Vol. 113; no. Supplement; p. S400
• Main Authors: Reich, Jason, Pei-Hsuan, Li, Zahorian, Toni, Noronha, Ansu, Wasan, Sharmeel K., Farraye, Francis A.
• Format: Journal Article
• Language: English
• Published: New York Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.10.2018
• Subjects: Crohn's disease; Gastroenterology; Immunization; Immunocompetence; Inflammatory bowel disease; Patients; Vaccines
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/00000434-201810001-00712

Introduction: Patients with inflammatory bowel disease (IBD) are at increased risk for developing herpes zoster (HZ). In October 2017 the FDA approved a two dose adjuvanted, recombinant zoster vaccine (RZV-Shingrix).The ACIP now recommends RZV over the HZ live-attenuated vaccine (ZVL) for immunocompetent adults aged 50 years and older and for immunocompetent adults who previously received ZVL. RZV contains a potent adjuvant that enhances its immunogenicity. There is a theoretical concern that patients with immune mediated diseases may develop worsening of their condition after RZV administration. As part of an ongoing quality improvement project to increase vaccination rates in patients with IBD, we are recommending RZV to all our patients with IBD 50 years and older monitoring for disease exacerbation after administration of RZV. Methods: RZV was prescribed to 46 patients as part of their routine care but only 14 have received the vaccine to date due to vaccine shortages. Only 2 patients have received their second dose. Most of these patients received the vaccine at their local pharmacy due to limited availability and insurance preference. Demographics including age, gender, IBD type, medications at the time of vaccine were recorded as well HBI and SCCAI at the time of administration and during follow-up office visit or phone call. Results: RZV was administered to 14 patients (7 men and 7 women). No patient had a previous history of HZ. The average age was 62 years (range 51-78). Nine patients had Crohn's disease and 5 had ulcerative colitis. Three (21%) were on a biologic, 2 (14%) on an immunomodulator (6 mercaptopurine or methotrexate) and 1 on tofacitinib. Six of these patients had previously received the live HZ vaccine. Four (29 %) of the patients had a local vaccine reaction but none had a systemic adverse reaction. The average follow-up after vaccine administration was 48 days (range 5-96 days). No patient had a worsening of their IBD based on HBI or SCCAI scores during this short term follow-up study. One patient with active ulcerative colitis at the time of vaccination had ongoing disease activity. Conclusion: In this preliminary report of a quality improvement project to increase vaccination rates in patients with IBD, no patient receiving vaccination with RZV had an exacerbation of their IBD. We continue to enroll patients. Larger studies with long term follow-up are needed to confirm that immune mediated diseases including IBD are not worsened after vaccination with RZV.