Protecting patients with SLE against herpes zoster: time for early proactive vaccine counselling

Vaccination is an effective strategy to mitigate the risk and disease burden of herpes zoster (shingles). With the arrival of a recombinant subunit vaccine (Shingrix), in addition to the longer lasting, live-attenuated vaccine (Zostavax), a window of opportunity exists to optimise protection against herpes zoster in patients with immune-mediated inflammatory diseases without risk of infection. However, since the recombinant zoster vaccine was introduced in 2018, data on the safety and effectiveness in patients with immune-mediated inflammatory diseases are scarce. Consequently, consensus on tailored vaccination strategies prioritising individuals at high risk of herpes zoster is absent, despite evidence that some patients—notably, those with systemic lupus erythematosus (SLE)—are at increased risk of herpes zoster and its complications. 1 Furer V Rondaan C Heijstek M et al. Incidence and prevalence of vaccine preventable infections in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD): a systemic literature review informing the 2019 update of the EULAR recommendations for vaccination in adult patients with AIIRD. RMD Open. 2019; 5e001041 Google Scholar Therefore, it is highly relevant to investigate the safety and effectiveness of the recombinant zoster vaccine in patients with immune-mediated inflammatory diseases and critically discuss the necessity of herpes zoster vaccine counselling. Immunogenicity, reactogenicity, and safety of two-dose adjuvanted herpes zoster subunit vaccine in patients with systemic lupus erythematosus in South Korea: a single-centre, randomised, double-blind, placebo-controlled trialThe herpes zoster subunit vaccine induces humoral and cellular immunity against herpes zoster with a good safety profile in patients with SLE. A larger study is warranted to assess the efficacy of vaccines to prevent herpes zoster in patients with SLE. Full-Text PDF