Background More than one million herpes zoster (HZ) cases occur in the United States every year. Currently, the live zoster vaccine is recommended for healthy older patients age ≥60 years. Whether the absolute risk for younger patients who have autoimmune or inflammatory conditions might be high enough to warrant vaccination of younger patients with these diseases is unclear.
Objectives To evaluate the overall and age-stratified absolute incidence of HZ infections associated with different autoimmune and inflammatory diseases compared to the general population currently recommended for vaccination by the CDC.
Methods We assembled 7 autoimmune and inflammatory disease cohorts using the Multi-Payer Claims Database (MPCD) using data from 2007-2010. All patients with at least one prescription and two diagnoses of RA, PsA, PsO, AS, IBD, SLE, gout were included and compared with two comparison cohorts: a cohort of diabetic patients and patients without any autoimmune disease or diabetes. Eligible patients in the nine cohorts were required to have at least 13 months continuous medical and pharmacy coverage. Patients were followed until they experienced HZ, died, lost coverage or December 31, 2010. We identified HZ using diagnosis codes and antiviral medication ±30 days. Age standardized incidence rates (IR) per 1,000 person-years were calculated for each cohort.
Results The study population consisted of 66,941 subjects with RA, 4,460 with PsA, 5,986 with Pso, 1,891 with AS, 11,494 with IBD, 12,984 with SLE, 80,022 with gout, 192,676 with diabetes and 355,884 in the healthy cohort. The age standardized IRs among the 7 autoimmune and inflammatory disease cohorts (Table) ranged from a high of 14.1 per 1,000 person years (SLE) to a low of 3.9 (gout). For diabetes, the associated age-standardized rate was 3.5/1000 and for healthy cohorts was 3.0/1000. The age-specific rate of HZ for RA, IBD and SLE patients age ≥40 was greater than the corresponding rate in healthy individuals age ≥60.
Conclusions SLE, IBD and RA are associated with an increased incidence rate of HZ infection compared to healthy older people. Based upon comparable absolute risk to healthy individuals age ≥60, SLE, IBD and RA patients age ≥40 might reasonably be considered as appropriate candidates for vaccination for HZ.
Disclosure of Interest J. Curtis Grant/research support: Research grants and/or consulting for unrelated work with Amgen, Abbott, BMS, Celgene, Centocor, CORRONA, Crescendo, Genentech, Janssen, Pfizer, Roche, UCB, H. Yun Grant/research support: unrelated work from AMGEN, S. Yang: None declared, L. Chen: None declared, K. Winthrop Grant/research support: Research grants and/or consulting for unrelated work with Pfizer, UCB, Genentech, F. Xie: None declared, J. Baddley Consultant for: Consultant for unrelated work for Pfizer, Astellas, Merck, Mayne Pharma, K. Saag: None declared, J. Singh Grant/research support: received research grants for unrelated work from Takeda and Savient and consultant fees from Savient, Takeda, Regeneron and Allergan, H. Yun: None declared