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In Reply I—Risk of Disseminated Disease in Immunosuppressed Patients Receiving Live Zoster Vaccine

      The package insert for Zostavax lists “immunosuppression or immunodeficiency” as contraindications for use, so complications resulting from its use in a very highly immunosuppressed patient may be anticipated.
      However, reports of such complications, such as those described by Dr Young, remain rare. The risks of Zostavax become notable somewhere between moderate and very high levels of immunosuppression, and data, such as results from the ongoing VERVE trial

      A Pilot Study of the Safety and Effectiveness of the Live Zoster Vaccine in Anti-TNF Users. ClinicalTrials.gov Identifier NCT01967316.

      of vaccination during treatment with anti–tumor necrosis factor therapy, are needed to define risks in specific populations. In the case described by Dr Young, dissemination occurred 45 days after vaccination, whereas current trials of Zostavax vaccination during immunosuppression have a shorter window for evaluation of vaccine safety.

      References

      1. Zostavax [package insert]. Merk & Co, Inc, Whitehouse Station, NJ2006: 2014
      2. A Pilot Study of the Safety and Effectiveness of the Live Zoster Vaccine in Anti-TNF Users. ClinicalTrials.gov Identifier NCT01967316.

      Linked Article

      • Risk of Disseminated Disease in Immunosuppressed Patients Receiving Live Zoster Vaccine
        Mayo Clinic ProceedingsVol. 91Issue 7
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          I read with interest the letter by Bubb1 and the reply by Cheetham et al2 in the November 2015 issue of Mayo Clinic Proceedings regarding the risk of disseminated disease in immunosuppressed patients receiving live zoster vaccine. Although the vaccine has been found to be highly effective and there is a paucity of cases of vaccine-related infections, the following report serves to highlight the need for caution when immunizing highly immunosuppressed patients.
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