Shingles

COPD, RA, and CKD Patients at High Risk for Shingles

Patients with autoimmune diseases (eg, COPD or asthma) and chronic conditions (eg, rheumatoid arthritis, chronic kidney disease, or depression) have a higher risk of developing shingles.

Shingles, or herpes zoster, predominately affect older patients, with lifetime risk increasing from 30% to 50% in persons over 85 years old. ___________________________________________________________________________________________________________________________________________________________________

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A risk-reducing vaccine exists for the disease, but because age is considered the most important risk factor and the vaccine is expensive, it is only used in patients over 60 years old.

In order to quantify the effect of other possible risk factors for shingles, as well as to determine whether younger persons with these factors may benefit from the vaccination, Harriet Forbes, MSc, and colleagues from the London School of Hygiene and Tropical Medicine, conducted a matched case-control study involving 144,959 cases of shingles as well as 549,336 controls, median age 62 years.

Using conditional logistic regression, researchers generated odds ratios for a list of potential risk factors for shingles, as well as the effects of these factors in connection to the patient’s age.

Factors that increased the risk of shingles included:

  • Rheumatoid arthritis, odds ratio (OR) 1.46
  • COPD, OR 1.32
  • Inflammatory bowel disease, OR 1.36
  • Asthma, OR 1.21
  • Chronic kidney disease, OR 1.14
  • Depression, OR 1.15

The relative effects of these risk factors were observed to be higher in younger patients. However, the rates remain low among patients 18-49 years, despite the high risk factors in this age group.

Type 1 (OR 1.26), but not type 2, diabetes showed some association with zoster.

Overall, the greatest risk for shingles was observed in patients with severe immunosuppression, including those with HIV, lymphoma, and stem-cell transplants. In these patients, the herpes zoster vaccine is often contraindicated.

“What this study has highlighted…is that the strongest clinical risk factors for zoster are contraindications to its vaccine; the people arguably in most need of protection against zoster cannot currently benefit from vaccination,” researchers concluded.

“Alternative risk reduction strategies in these patients would help those at greatest risk of this disease and its complications.”

–Michael Potts

Reference:

Forbes HJ, Bhaskaran K, Thomas SL, et al. Quantification of risk factors for herpes zoster: population based case-control study. BMJ. 2014;348:g2911.