Is zoster vaccine (Zostavax) contraindicated in a 75-year-old woman who receives rituximab (Rituxan) injections every three months for her rheumatoid arthritis?
—LARRY LAMASTERS, PA-C, Fairbank, Iowa

Yes. Because it is a live attenuated vaccine, the zoster vaccine is not recommended for use in pregnant women or patients with primary or acquired immunodeficiencies (including leukemia, lymphoma, or other malignancies affecting the bone marrow or lymphatic system), AIDS, and patients on immunosuppressive therapies. For additional information, see N Engl J Med. 2007;356:1338-1343.
—Reuben W. Zimmerman, PA-C