Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Zoster vaccination is underused but looks effective in IBD

Key clinical point: Herpes zoster vaccination appears effective in patients with inflammatory bowel disease.

Major finding: Vaccination was tied to a significantly reduced risk of herpes zoster infection, compared with no vaccination (adjusted hazard ratio, 0.54; 95% confidence interval, 0.44-0.68).

Study details: Retrospective cohort study of 7,170 patients in the national Veterans Affairs Healthcare System.

Disclosures: Pfizer provided funding. Dr. Khan disclosed research funding from Pfizer, Luitpold, and Takeda. One coinvestigator disclosed ties to Pfizer, Gilead, Merck, AbbVie, Lilly, Janssen, Johnson & Johnson, UCB, and Nestle Health Science. The remaining researchers reported having no conflicts.


Khan N et al. Clin Gastroenterol Hepatol. 2018 Oct 13. doi: 10.1016/j.cgh.2018.10.016.


Preventive care is an underemphasized component of IBD management because the primary focus tends to be control of active symptoms. However, as patients are treated with immunosuppression, particularly combinations of therapies and newer mechanisms of action such as the Janus kinase inhibitors, the risk of infections increases, including those that are vaccine preventable including shingles and its related complications. This study by Khan et al. highlights several important messages for patients and providers. First, in this large older IBD cohort, the vaccination rates were very low at 18% even though more than 80% of patients had more than six annual visits to the VA Health Systems during the study period. These represent multiple missed opportunities to discuss and administer vaccinations. Second, the authors highlighted the vaccine’s efficacy: Persons receiving herpes zoster vaccination had a clearly decreased risk of subsequent infection. While the number of vaccinated patients on immunosuppression was too small to draw conclusions about efficacy, the live attenuated vaccination is contraindicated for immunosuppressed patients. However, the newer recombinant shingles vaccine offers the opportunity to extend the reach of shingles vaccination to include those on immunosuppression. As utilization of the newer vaccine series increases, we will be able to evaluate the efficacy for immunosuppressed IBD patients, although studies from other disease states suggest efficacy. However, vaccinations will never work if they aren’t administered. Counseling patients and providers regarding the importance of vaccinations is a low-risk, efficacious means to decrease infection and associated morbidity.

Christina Ha, MD, AGAF, associate professor of medicine, Inflammatory Bowel Disease Center, division of digestive diseases, Cedars-Sinai Medical Center, Los Angeles. She is a speaker, consultant, or on the advisory board for AbbVie, Janssen, Genentech, Samsung Bioepis, and Takeda. She received grant funding from Pfizer.