title: Herpes Zoster Vaccine Response in Inflammatory Bowel Disease Patients on Low-dose Immunosuppression.
abstract: Inflammatory Bowel Disease (IBD) patients are at an increased risk of developing herpes zoster (HZ), especially when immunosuppressed. HZ may be preventable with the herpes zoster vaccine (HZV), but many patients are not offered vaccination over concern regarding efficacy and fear of adverse events. Although the Center for Disease Control and Prevention recommends that low-dose immunosuppression is not a contraindication, few IBD patients on these medications are receiving HZV.
  
  
  
  This study was a prospective clinical trial to assess the safety and immunogenicity of HZV among 2 groups of IBD patients. Group A consisted of 14 patients on low-dose immunomodulators and group B consisted of 25 patients either on 5-aminosalicylic acid or no IBD therapy. Blood samples were obtained to measure immune responses.
  
  
  
  HZ specific immunoglobulin G rose significantly in both groups but the response was lower in the immunosuppressed group (P = 0.0002). Peripheral blood mononuclear cell secretion of Tumor necrosis factor-α in response to HZ antigen increased after HZV in group B, but not in group A. Interleukin-8 secretion increased in both groups, but the response was much higher in group B. There were no significant differences in adverse events between groups. No patients developed a HZ-like rash within 1 year after vaccination.
  
  
  
  IBD patients on low-dose immunosuppressive therapy have a blunted immune response to HZV as compared with nonimmunosuppressed subjects. Despite this, immunosuppressed IBD patients are able to mount a statistically significant immune response. There were no serious adverse events to HZV.
authors.affiliation: Departments of *Gastroenterology and †Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; ‡Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and §Department of Infectious Diseases, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Sharmeel K
authors.initials: SK
authors.lastname: Wasan
authors.forename: Samantha
authors.initials: S
authors.lastname: Zullow
authors.forename: Adam
authors.initials: A
authors.lastname: Berg
authors.forename: Adam S
authors.initials: AS
authors.lastname: Cheifetz
authors.forename: Lisa
authors.initials: L
authors.lastname: Ganley-Leal
authors.forename: Francis A
authors.initials: FA
authors.lastname: Farraye
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000097:blood* / Q000494:pharmacology; D002478:Cells, Cultured; D005260:Female; D053061:Herpes Zoster Vaccine / Q000009:adverse effects* / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D015212:Inflammatory Bowel Diseases / Q000097:blood / Q000188:drug therapy*; D016209:Interleukin-8 / Q000378:metabolism; D007963:Leukocytes, Mononuclear / Q000187:drug effects / Q000378:metabolism; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000914:Antibodies, Viral; D053061:Herpes Zoster Vaccine; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D019804:Mesalamine