HERPES ZOSTER DURING IMMUNOSUPPRESSIVE THERAPY FOR AUTOIMMUNE DISEASES
AbstractBackground: Patients on immunosuppressive therapy are at a greater risk for herpes zoster reactivation and are more likely to have adverse outcomes. Propylactic antivrials and vaccinations may potentially prevent these complications. Methods: Medical literature addressing the clinical course and therapy of herpes zoster in patients receiving immunosuppressive therapy for autoimmune disorders, and the roles of anti-viral prophylaxis and vaccination was reviewed. Research databases including PubMed, Ovid, Medline, Google Scholar and Cochrane were utilized. Results: Acyclovir and its derivatives are most commonly used in this setting for treatment and reduction of post-zoster complications. Foscarnet may be used for acyclovir-resistant strains. At both conventional and ultra-low doses, acyclovir has proven effective when used as prophylaxis, reducing the incidence of zoster and its complications in immunosuppressed patients. Additionally, ultra-low doses are associated with significantly reduced side effects. The zoster vaccine, Zostavax, a live-attenuated vaccine has shown promising results in several clinical trials. However, live-attenuated vaccines should be cautiously used in immunosuppressed patients. For patients who require immunosuppressive therapy, vaccination 2–3 months prior to therapy may be appropriate. Conclusions: Prophylactic antiviral therapy and vaccination help significantly reduce morbidity and mortality from zoster reactivation in patients receiving immunosuppressive therapy.Keywords: Herpes zoster; Autoimmune diseases; Immunosuppressive therapy; Prophylaxis; Vaccination
Chakravarty EF. Viral infection and reactivation in autoimmune disease. Arthritis Rheum 2008;58(10):2949–57.
Erard V, Guthrie KA, Varley C, Heugel J, Wald A, Flowers MED, et al. One-year acyclovir prophylaxis for preventing varicella-zoster virus disease after hematopoietic cell transplantation: no evidence of rebound varicella-zoster virus disease after drug discontinuation. Blood 2007;110(8):3071–7.
Strangfeld A, Listing J, Herzer P, Liebhaber A, Rockwitz K, Richter C, et al. Risk of herpes zoster in patients with rheumatoid arthritis treated with anti-TNF-alpha agents. JAMA 2009;301(7):737–44.
Wung PK, Holbrook JT, Hoffman GS, Tibbs AK, Specks U, Min YI, et al. Herpes zoster in immunocompromised patients: incidence, timing, and risk factors. Am J Med 2005;118(12):1416.
Chen SY, Suaya JA, Li Q, Galindo CM, Misurski D, Burstin S, et al. Incidence of herpes zoster in patients with altered immune function. Infection 2014;42(2):325–34.
Gluck T, Muller-Ladner U. Vaccination in patients with chronic rheumatic or autoimmune diseases. Clin Infect Dis 2008;46(9):1459–65.
Adams DJ, Nylund CM. Hospitalization for Varicella and Zoster in Children with Inflammatory Bowel Disease. J Pediatr 2016;171:140–5.
Klein A, Miller KB, Sprague K, DesJardin JA, Snydman DR. A randomized, double-blind, placebo-controlled trial of valacyclovir prophylaxis to prevent zoster recurrence from months 4 to 24 after BMT. Bone Marrow Transplant 2011;46(2):294–9.
Kimberlin DW, Whitley RJ. Varicella-zoster vaccine for the prevention of herpes zoster. N Engl J Med 2007;356(13):1338–43.
Kotton CN. Nailing down the shingles in IBD. Inflamm Bowel Dis 2007;13(9):1178–9.
Posfay-Barbe KM, Pittet LF, Sottas C, Grillet S, Wildhaber BE, Rodriguez M, et al. Varicella-zoster immunization in pediatric liver transplant recipients: safe and immunogenic. Am J Transplant 2012;12(11):2974–85.
Sandherr M, Einsele H, Hebart H, Kahl C, Kern W, Kiehl M, et al. Antiviral prophylaxis in patients with haematological malignancies and solid tumours: Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Oncology (DGHO). Ann Oncol 2006;17(7):1051–9.
Schimpff S, Serpick A, Stoler B, Rumack B, Mellin H, Joseph JM, et al. Varicella-Zoster infection in patients with cancer. Ann Intern Med 1972;76(2):241–54.
Singh A, Englund K. Q: Who should receive the shingles vaccine? Cleve Clin J Med 2009;76(1):45–8.
Hata A, Asanuma H, Rinki M, Sharp M, Wong RM, Blume K, et al. Use of an inactivated varicella vaccine in recipients of hematopoietic-cell transplants. N Engl J Med 2002;347(1):26–34.
O'Connor MB, Phelan MJ. Herpes zoster infection, vaccination and immunocompromised rheumatology patients. Rheumatol Int 2013;33(1):239–40.
Zhang J, Delzell E, Xie F, Baddley JW, Spettell C, McMahan RM, et al. The use, safety, and effectiveness of herpes zoster vaccination in individuals with inflammatory and autoimmune diseases: a longitudinal observational study. Arthritis Res Ther 2011;13(5):R174.
Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ, Mahalingam R, Cohrs RJ. Neurologic complications of the reactivation of varicella-zoster virus. N Engl J Med 2000;342(9):635–45.
Gourishankar S, McDermid JC, Jhangri GS, Preiksaitis JK. Herpes zoster infection following solid organ transplantation: incidence, risk factors and outcomes in the current immunosuppressive era. Am J Transplant 2004;4(1):108–15.
Fehr T, Bossart W, Wahl C, Binswanger U. Disseminated varicella infection in adult renal allograft recipients: four cases and a review of the literature. Transplantation 2002;73(4):608–11.
Gnann JW Jr. Varicella-zoster virus: atypical presentations and unusual complications. J Infect Dis 2002;186(Suppl 1):S91–8.
Manuel O, Kumar D, Singer LG, Cobos I, Humar A. Incidence and clinical characteristics of herpes zoster after lung transplantation. J Heart Lung Transplant 2008;27(1):11–6.
Manzi S, Kuller LH, Kutzer J, Pazin GJ, Sinacore J, Medsger TA Jr, et al. Herpes zoster in systemic lupus erythematosus. J Rheumatol 1995;22(7):1254–8.
Nesher L, Rolston KV. The current spectrum of infection in cancer patients with chemotherapy related neutropenia. Infection 2014;42(1):5–13.
Ahmed AM, Brantley JS, Madkan V, Mendoza N, Tyring SK. Managing herpes zoster in immunocompromised patients. Herpes 2007;14(2):32–6.
Korelitz BI, Fuller SR, Warman JI, Goldberg MD. Shingles during the course of treatment with 6-mercaptopurine for inflammatory bowel disease. Am J Gastroenterol 1999;94(2):424–6.
Shepp DH, Dandliker PS, Meyers JD. Treatment of varicella-zoster virus infection in severely immunocompromised patients. A randomized comparison of acyclovir and vidarabine. N Engl J Med 1986;314(4):208–12.
Whitley RJ, Ch'ien LT, Dolin R, Galasso GJ, Alford CA Jr. Adenine arabinoside therapy of herpes zoster in the immunosuppressed. NIAID collaborative antiviral study. N Engl J Med 1976;294(22):1193–9.
Balfour HH Jr. Varicella zoster virus infections in immunocompromised hosts. A review of the natural history and management. Am J Med 1988;85(2A):68–73.
Vilde JL, Bricaire F, Leport C, Renaudie M, Brun-Vezinet F. Comparative trial of acyclovir and vidarabine in disseminated varicella-zoster virus infections in immunocompromised patients. J Med Virol 1986;20(2):127–34.
Balfour HH Jr, McMonigal KA, Bean B. Acyclovir therapy of varicella-zoster virus infections in immunocompromised patients. J Antimicrob Chemother 1983;12 (Suppl B):169–79.
Wiegering V, Schick J, Beer M, Weissbrich B, Gattenlohner S, Girschick HJ, et al. Varicella-zoster virus infections in immunocompromised patients - a single centre 6-years analysis. BMC Pediatr 2011;11(1):31.
Safrin S, Crumpacker C, Chatis P, Davis R, Hafner R, Rush J, et al. A controlled trial comparing foscarnet with vidarabine for acyclovir-resistant mucocutaneous herpes simplex in the acquired immunodeficiency syndrome. The AIDS Clinical Trials Group. N Engl J Med 1991;325(8):551–5.
Koc Y, Miller KB, Schenkein DP, Griffith J, Akhtar M, DesJardin J, et al. Varicella zoster virus infections following allogeneic bone marrow transplantation: frequency, risk factors, and clinical outcome. Biol Blood Marrow Transplant 2000;6(1):44–9.
Asano-Mori Y, Kanda Y, Oshima K, Kako S, Shinohara A, Nakasone H, et al. Long-term ultra-low-dose acyclovir against varicella-zoster virus reactivation after allogeneic hematopoietic stem cell transplantation. Am J Hematol 2008;83(6):472–6.
Baden LR, Bensinger W, Angarone M, Casper C, Dubberke ER, Freifeld AG, et al. Prevention and treatment of cancer-related infections. J Natl Compr Canc Netw 2012;10(11):1412–45.
Oxman MN. Zoster vaccine: current status and future prospects. Clin Infect Dis 2010;51(2):197–213.
Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005;352(22):2271–84.
Sarkadi J. Varicella-zoster virus vaccine, successes and difficulties. Acta Microbiol Immunol Hung 2013;60(4):379–96.
Gelb LD. Reducing the incidence and severity of herpes zoster and PHN with zoster vaccination. J Am Osteopath Assoc 2009;109(6 Suppl 2):S18–21.
Harpaz R, Ortega-Sanchez IR, Seward JF. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2008;57(RR-5):1–30.
Lobermann M, Borso D, Hilgendorf I, Fritzsche C, Zettl UK, Reisinger EC. Immunization in the adult immunocompromised host. Autoimmun Rev 2012;11(3):212–8.
Guthridge JM, Cogman A, Merrill JT, Macwana S, Bean KM, Powe T, et al. Herpes zoster vaccination in SLE: a pilot study of immunogenicity. J Rheumatol 2013;40(11):1875–80.
Cheetham TC, Marcy SM, Tseng HF, Sy LS, Liu IL, Bixler F, et al. Risk of Herpes Zoster and Disseminated Varicella Zoster in Patients Taking Immunosuppressant Drugs at the Time of Zoster Vaccination. Mayo Clin Proc 2015;90(7):865–73.
Zhang J, Xie F, Delzell E, Chen L, Winthrop KL, Lewis JD, et al. Association between vaccination for herpes zoster and risk of herpes zoster infection among older patients with selected immune-mediated diseases herpes zoster and immune-mediated diseases. JAMA 2012;308(1):43–9.
Feldman S, Lott L. Varicella in children with cancer: impact of antiviral therapy and prophylaxis. Pediatrics 1987;80(4):465–72.