Those with IBD may be more susceptible to infections because of the medications commonly prescribed, and shingles are no exception. Herpes zoster, or shingles, is a reactivation of the chickenpox virus in the body, resulting in a painful rash or rashes usually on the trunk of the body. The IBD population has already been estimated to have a 1.2-1.8 times higher risk for developing shingles. This may sound like a minor risk, but considering over 200,000 people in the US alone are diagnosed annually puts it more into perspective. While it’s not fully understood what reactivates this virus, shingles do have an adult vaccine, shingrix, that is helping IBD patients lower their risk more than twofold.
This two-dose vaccine was approved by the FDA in 2017 to prevent shingles in adults 50 and older. As a relatively new vaccine, however, only 10.9% of those 50-60, and 20.5% of those 60 and over have been fully vaccinated, leaving a large gap to fill in. We have also seen a recent rise overall in IBD in the older adult population. A 3.4% rise was seen in Crohn’s, and 2.8% in Ulcerative Colitis. This new rise puts the older adult IBD population at even more risk. Especially for those taking thiopurines, anti-TNF medications, and corticosteroids. With such low vaccination rates as of right now, doctors need to be recommending this vaccine for 50 plus and providing education, especially for those who have IBD.
This study looked at 33,000 patients with IBD, 50 and older using the national Veterans Affairs Healthcare System’s information. Participants were divided into two groups based on age. The first group is 50-60, the second being that 60 plus. Following full two-dose vaccination, those 50-60 reduced their risk from 3.93 all the way to 0.00. For that 60 plus, they were able to reduce risk from 4.57 to 1.80 showing just how effective this vaccine can be. The overall hazard ratios were reduced to 0.00 and 0.39 respectively. Those who only received one vaccine instead of the full two doses only reduced their hazard ratio from 3.93 to 1.79 for those 50-60, and 4.57 to 2.48 for that 60 plus. These numbers reflect an insignificant difference from no vaccination at all, driving home the importance of the full two doses.
Those who reported the least instances of developing shingles among older IBD patients were those who had been fully vaccinated, and on either vedolizumab (Entyvio), ustekinumab (Stelara), and tofacitinib (Xeljanz) with a total of zero instances reported. Those who took these medications and were not vaccinated also reported lower instances suggesting a possible link. There are a few limitations of this study, including that 82% of participants were men. This study also is limited to only the veteran IBD population, as well as more participants having UC rather than Crohn’s. This study was monumental in the fact that it was the first to look at the efficacy of Shingrix in immunosuppressed patients. With these positive results, we are sure to see more studies involving Shingrix and the IBD population in the near future.    Â
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