Research from the University of Alabama at Birmingham School of Public Health indicates that patients with certain autoimmune diseases may benefit from vaccination against varicella zoster virus (VZV), also known as herpes zoster, according to a paper presented at the recent American College of Rheumatology/Association of Rheumatology Health Professionals Annual Meeting in Boston.

The diseases with the highest risk of varicella zoster virus (VZV) infection included rheumatoid arthritis (RA), inflammatory bowel disease (IBD), and lupus when compared with healthy patients. Therefore, Huifeng Yun, MD, PhD, and colleagues concluded that patients aged older than 30 years who have these may benefit from immunization with VZV vaccine (Zostavax).

To calculate this risk, the researchers used 2007 to 2010 data from the Multi-Payer Claims Database. More than 80,000 patients were included in the study, including 50,646 with RA; 2,629 with PsA; 4,299 with psoriasis; 1,019 with AS; 7,916 with IBD; 8,395 with lupus; and 5,893 with gout. Inclusion criteria included patients with at least one prescription and two diagnoses of autoimmune diseases. Patients were required to have at least 13 months continuous medical and pharmacy coverage. These data were compared with 214,631 patients with diabetes and 330,727 healthy patients.

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The investigators calculated age-adjusted incidence rates (AAIR) and age-specific rates for VZV per 1,000 person-years for each disease and compared them with healthy older people aged 60 to 69 years using Poisson regression. The AAIR was highest among lupus patients (14.6 per 1,000 person) and lowest among patients with gout (5.0 per 1,000 person). The AAIR was 5.9 per 1,000 person years for diabetes and 3.9 per 1,000 person years for the healthy cohort.

Compared with the healthy cohort, the adjusted hazard ratio for RA (1.4, 95% CI: 1.2-1.5), gout (1.4, 1.2-1.5), IBD (1.8, 1.5-2.1) and lupus (2.1, 1.8-2.4) were increased significantly, according to the abstract presented at the meeting.

“RA, IBD and lupus are associated with an increased risk of herpes zoster infection compared to healthy people. Based on absolute risk compared to healthy people aged 60 years and older, RA, IBD and SLE patients aged older than 30 years may benefit from vaccination for herpes zoster,” according to the abstract presented at the meeting.


  1. Huifeng Yun. Paper Number:820. Presented at: ACR/ARHP Annual Meeting; Nov. 14-19, 2014; Boston.


Yun reports a financial relationship with Amgen.