title: Risk of Herpes Zoster and Disseminated Varicella Zoster in Patients Taking Immunosuppressant Drugs at the Time of Zoster Vaccination.
abstract: OBJECTIVE
  To determine the risks associated with zoster vaccine when administered to patients taking immunosuppressant medications.
  
  
  METHODS
  Patients enrolled in 1 of 7 managed care organizations affiliated with the Vaccine Safety Datalink between January 1, 2006, and December 31, 2009, were eligible. The exposure of interest was zoster vaccination in patients with current or remote immunosuppressant drug use. The primary outcomes were disseminated varicella zoster virus (VZV) and herpes zoster in the 42 days after vaccination. Automated data were collected on immunosuppressant drugs and baseline medical conditions. A logistic regression model using inverse probability treatment weights was used to estimate the odds of developing VZV or herpes zoster.
  
  
  RESULTS
  A total of 14,554 individuals had an immunosuppressant medication dispensed around the time of vaccination, including 4826 with current use and 9728 with remote use. Most patients were taking low-dose corticosteroids. No cases of disseminated VZV were found in the current or remote users. The risk of herpes zoster was elevated in the 42 days after vaccination in current vs remote users (adjusted odds ratio, 2.99; 95% CI, 1.58-5.70).
  
  
  CONCLUSIONS
  We found that patients taking immunosuppressant medications at the time of vaccination had a modest increased risk of herpes zoster in the 42 days after vaccination. The development of herpes zoster within 42 days after vaccination suggests that this is more likely due to reactivation of latent zoster virus than dissemination of the vaccine-derived varicella virus. These findings support the current zoster vaccination guidelines.
authors.affiliation: Research and Evaluation, Kaiser Permanente Southern California, Pasadena. Electronic address: craig.t.cheetham@kp.org.
authors.forename: T Craig
authors.initials: TC
authors.lastname: Cheetham
authors.affiliation: Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: S Michael
authors.initials: SM
authors.lastname: Marcy
authors.affiliation: Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Hung-Fu
authors.initials: HF
authors.lastname: Tseng
authors.affiliation: Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Lina S
authors.initials: LS
authors.lastname: Sy
authors.affiliation: Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: In-Lu Amy
authors.initials: IL
authors.lastname: Liu
authors.affiliation: Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Felicia
authors.initials: F
authors.lastname: Bixler
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland.
authors.forename: Roger
authors.initials: R
authors.lastname: Baxter
authors.affiliation: Marshfield Clinic Research Foundation, Marshfield, WI.
authors.forename: James G
authors.initials: JG
authors.lastname: Donahue
authors.affiliation: Kaiser Permanente Northwest, Portland, OR.
authors.forename: Allison L
authors.initials: AL
authors.lastname: Naleway
authors.affiliation: Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Jacobsen
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006562:Herpes Zoster / Q000453:epidemiology* / Q000517:prevention & control; D053061:Herpes Zoster Vaccine / Q000627:therapeutic use*; D014645:Herpesvirus 3, Human / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000379:methods*
chemical_list: D053061:Herpes Zoster Vaccine; D007166:Immunosuppressive Agents