Prevention and management of herpes zoster in patients with rheumatoid arthritis and psoriatic arthritis: a clinical review

Abstract

The risk of herpes zoster (HZ) and HZrelated complications is increased in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) relative to the general population; therefore, HZ vaccination is recommended in these patient groups. In this literature-based review, we summarise the available evidence on the use of HZ vaccines in patients with RA and PsA, and discuss strategies for managing breakthrough infection. Currently available data show suboptimal rates of HZ vaccination among these patients and highlight a need for strategies to improve HZ vaccination programmes in clinical practice. Further clinical studies are also required to optimise the use of HZ vaccines in patients with RA and PsA, particularly with regard to determining the impact of different immunosuppressive therapy regimens on vaccine immunogenicity and, ultimately, efficacy, as well as the impact of vaccination on disease activity and safety.

2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases

“…Acknowledging that status of VZV-immunity can be affected by various factors, including national regulations, access to testing, as well as previous vaccination or infection history, it was considered appropriate not to formulate a specific recommendation on this issue; however, the TF advocates the importance of establishing VZV-immunity status through a detailed past medical history of previous exposure, for example, chickenpox. Mainly based on published expert opinion178 179 the TF agreed that those identified as non-immune or where there is doubt about their immunity status, should be informed in advance about post-exposure prophylaxis and offered prophylaxis after contact with a person with chickenpox or shingles, according to local guidelines. There is no evidence about the level of immunosuppression/immunomodulation (type of treatment) above which, patients would have a benefit from postexposure prophylaxis.…”

“…This has been noted in the research agenda. Prophylaxis with antivirals against reactivation of herpes zoster infection (shingles), as has been suggested by some in the literature (largely expert opinion), [179][180][181] could not be Figure 1 Typical screening for hepatitis B virus (HBV) status include HBsAg, anti-HBcore and anti-HBs. HBsAg-positive patients (HBV carriers) would benefit from prophylactic treatment, and thus it is advised that they should be referred to hepatologist for anti-viral prophylactic treatment.…”

Vaccine Prophylaxis of Herpes Zoster In Rheumatic Diseases: Paradigm Revision and New Opportunities

“…В недавно опубликованном крупном клиническом обзоре авторы делают общий вывод о том, что пациенты с низким уровнем иммуносупрессии могут быть вакцинированы LZV за 4 нед. до начала иммуномодулирующей терапии, однако препаратом выбора в большинстве случаев признается HZ/su [33].…”

“…Oхват вакцинацией против HZ в большинстве стран остаётся недостаточным (субоптимальным). К наиболее частым причинам этого относят отсутствие рекомендации со стороны лечащего врача, недоверие к вакцине или боязнь нежелательных реакций [33]. Ретроспективный анализ, проведённый в США по материалам 2006-2009 гг., показал, что факторами, положительно влияющими на охват вакцинацией, являлись возраст 60-64 лет, отсутствие приёма иФНО-α, меньшее число коморбидных заболеваний и отсутствие факта госпитализации в течение последних 6 мес.…”

Successful Treatment of SARS-CoV-2 Vaccination-related Activation of Rheumatoid Arthritis with Positive Findings for Epstein-Barr Virus

“…For many patients with rheumatic diseases who are undergoing immunosuppressive treatment ( 1 , 2 ), vaccination ( 3 - 5 ) against specific microorganisms, such as herpes zoster or Streptococcus pneumonia , is important to prevent aggravation of the underlying diseases. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination for patients with rheumatoid arthritis (RA) or other rheumatic diseases is no exception.…”