Hot Off The Presses IBD Patients: Get with The Guidelines and Get Your Shingles Shots
Vaccine Preventable Diseases (VPD’s) are very much in the news lately with annual influenza epidemics and the new and increasingly prevalent nationwide measles and hepatitis A epidemics in the U.S. Because IBD patients—those with Ulcerative Colitis or Crohn’s disease—are often malnourished or undernourished, anemic, or immune-suppressed from the severity of their illness (or one of their treatments), a thorough assessment of infectious disease risk, VPD risk, and immunization status has assumed a prominent role in IBD patient care.
Hot off the presses this month (May 2019) from the journal Inflammatory Bowel Diseases is a study showing that the most common VPDs among patients with IBD were the herpes zoster shingles virus (HZV) (34.9%) and hepatitis B virus (31.6%), followed by influenza (22.1%), Pneumococcal pneumonia (9.1%) and hepatitis A (2.4%).
While assuring immunity to all VPDs is important, IBD patients were twice as likely as non-IBD patients to have shingles! OUCH. According to the Center for Disease Control, 97% of infections with Shingles can be prevented with the use of two vaccines licensed in the U.S.:
- Zoster vaccine live (ZVL, Zostavax) has been in use since 2006 and is more widely available. It can only be used in healthy patients who are not immune-suppressed because it is a LIVE vaccine.
- Recombinant zoster vaccine (RZV, Shingrix), has been in use since 2017 and is now recommended as the preferred shingles vaccine. It has been prone to shortages and is often available at major national pharmacy chains. Because it is a recombinant vaccine, it can be used in nearly all patients.
You should get Shingrix even if in the past you:
- Had shingles.
- Received Zostavax in the past.
- Are over 40-50 and are not sure if you had chickenpox (99% of Americans 40 years and older have had chickenpox, even if they don’t remember having the disease).
You should not get Shingrix if you:
- Have ever had a severe allergic reaction to any component of the vaccine or after a dose of Shingrix.
- Are under 40 and tested negative for immunity to varicella zoster virus. If you test negative, you should get a chickenpox vaccine.
- Currently, have shingles.
- Currently, are pregnant or breastfeeding. Women who are pregnant or breastfeeding should wait to get Shingrix.
- Receive specific antiviral drugs (acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination (avoid the use of these antiviral drugs for 14 days after vaccination)- zoster vaccine live only.
- Have a moderate or severe acute illness (you should usually wait until you recover before getting the vaccine. This includes anyone with a temperature of 101.3°F).
All of the board-certified specialists and specially trained non-physician practitioners at Greater Boston GI are happy to work with you and your PCP to help keep you VPD FREE.