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RA and Shingles Vaccine
Ellen7610 posted:
Hi Everyone,

I am 42 and have had RA for 20 years. I have been on a successful Enbrel protocol for several years. I was interested in getting the shingles vaccine, but everything I've read says that those with compromised immune systems (including those on drugs such as Enbrel) should not get the vaccine. However, most literature also states that those most susceptible to getting shingles are those with compromised immune systems. That seems to be a strange disconnect. I cannot find any explanation as to WHY those of us in that boat should not get the vaccine. Any explanation would be greatly appreciated. Thanks!
Scott Zashin, MD responded:
You are right. Patients who are taking immunosuppressive drugs have a higher risk of shingles, so if possible, it is best to vaccinate RA patients before going on these types of drugs. This is because the shingles vaccine is a live vaccine. As a result, there is a concern that taking it may increase the risk of developing shingles in patients who have a depressed immunity from medications. Since the vaccine has been out, I am now offering the vaccine to my patients on low dose prednisone, methotrexate and other oral immunosuppressives but not biologics like Enbrel., Humira etc. There was a recent study that looked at giving patients on biologics the Shingles vaccine and was presented at the American College of Rheumatology meeting last year. More study is needed before I will recommend the vaccine to my patients on these drugs, but hopefully information showing it is safe will be forthcoming as these patients may have the most to gain. As always, discuss the benefits and risks of your medications including vaccinations with your treating Rheumatologist.
jaxgirl1952 replied to Scott Zashin, MD's response:
I am 60 and just diagnosed with RA and I am only take OTC drugs at this point (aspirin) and we have not made a decision about other drugs yet. Does that mean that I can get the shingles shot?

Thank you.
Scott Zashin, MD replied to jaxgirl1952's response:
I permit my patients over 50 with RA who are not on biologics such as Enbrel and Humira and are not on high doses of prednisone to take the Shingles shot. I make sure that wait a specified period of time after the shingles shot if they plan to start these meds. If that is the case, check with your doctor on the appropriate time you need to wait before starting a biologic.
jaxgirl1952 replied to Scott Zashin, MD's response:
Thank you!

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