Abstract
Abstract Background Adults with inflammatory bowel disease (IBD) are at higher risk of herpes zoster (HZ) compared to the general population. In 2021, the Advisory Committee on Immunization Practices recommended 2 doses of recombinant zoster vaccine (RZV) for the prevention of HZ and its complications in immunocompromised adults ≥19 years. In this study, we evaluated the vaccine effectiveness (VE) of RZV and risk of flares in adults ≥50 years with IBD. Methods To evaluate VE, we conducted a retrospective matched cohort analysis at Kaiser Permanente Southern California. We included individuals ≥50 years with IBD who received 2 doses of RZV at least 28 days apart during 04/01/2018–12/31/2021 and matched up to 1:3 to RZV unvaccinated individuals on condition (ulcerative colitis, Crohn’s disease), age, sex, race/ethnicity, IBD medication type, and index date (date of second dose among vaccinated individuals; same date assigned to unvaccinated match). Follow-up started the 31st day after the index date and ended at the earliest date of HZ occurrence, death, disenrollment, HZ vaccination or 12/31/2022. Stratified Cox proportional hazards regression was used to estimate adjusted hazard ratios and VE against HZ, identified by ICD-10 codes and antiviral medications. Using self-controlled case series analysis, we calculated the incidence of IBD new-onset flares in the risk (30 days after each dose) and comparison periods (90 - 61 days prior and 31 - 60 days after each dose) among patients with ≥1 RZV dose. The relative risk (RR) of IBD flare was estimated using conditional Poisson regression. All flares were identified through chart review. Results Of adults ≥50 years with IBD (n=872 2-dose vaccinated, 2550 unvaccinated), 55.4% were female, 74.0% were non-Hispanic white, and mean age was 68.4 years (standard deviation [SD] 9.0). Overall adjusted VE in preventing HZ was 65.1% (95% CI 24.8–83.8%). Among 1199 adults ≥50 years old with IBD receiving ≥1 dose of RZV (53.8% female, 69.6% non-Hispanic white, mean age 68.2 years [SD 9.1]), there was no increased risk of IBD flare within 30 days after RZV vaccination (RR: 0.80; 95% CI 0.47–1.35). Conclusion In adults aged ≥50 with IBD, 2 doses of RZV is effective in preventing HZ with no new safety concerns; RZV vaccination could benefit IBD patients who are at increased risk of HZ. Disclosures Emily Rayens, PhD, MPH, GSK: Grant/Research Support|Moderna: Grant/Research Support Lina S. Sy, MPH, Dynavax: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support Lei Qian, PhD, Dynavax: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support Jun Wu, MD, MS, Genentech: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|VoxelCloud: Grant/Research Support Bradley Ackerson, MD, Dynavax: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Yi Luo, PhD, GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Yanjun Cheng, Master of Science, GlaxoSmithKline: Grant/Research Support Avanish Patel, MD, GlaxoSmithKline: Grant/Research Support Zendi Solano, BS, Dynavax: Grant/Research Support|Gilead: Grant/Research Support|GlaxoSmithKline: Grant/Research Support Justine De Jesus, MPH, GlaxoSmithKline: Grant/Research Support Britta Amundsen, MA, Gilead: Grant/Research Support|GlaxoSmithKline: Grant/Research Support Ana Florea, PhD, MPH, Gilead: Grant/Research Support|GSK: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Jennifer H. Ku, PhD MPH, GSK: Grant/Research Support|Moderna: Grant/Research Support Elizabeth Chmielewski-Yee, PhD, MPH, GSK: Employee of GSK|GSK: Stocks/Bonds (Public Company) Driss Oraichi, PhD, GSK: I am a full time employee of GSK|GSK: Stocks/Bonds (Private Company) Harry Seifert, MD. MSCE, FISPE, GSK: full-time employee|GSK: Stocks/Bonds (Public Company) Huifeng Yun, MD, PhD, GSK: fulltime employee of GSK|GSK: Stocks/Bonds (Public Company) Hung Fu Tseng, PhD MPH, GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support
Published Version
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