Safety of inadvertent administration of live zoster vaccine to immunosuppressed individuals in a UK-based observational cohort analysis
Objectives To investigate the safety of live attenuated varicella zoster vaccination when administered to immunosuppressed individuals.Design Prospective observational cohort study.Setting The study used anonymised data from the Clinical Practice Research Datalink (CPRD), comprising a representative...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-01-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/1/e034886.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850136456880717824 |
|---|---|
| author | Nick Andrews Sara Thomas Daniel J Grint Helen I McDonald Jemma L Walker Gayatri Amirthalingam |
| author_facet | Nick Andrews Sara Thomas Daniel J Grint Helen I McDonald Jemma L Walker Gayatri Amirthalingam |
| author_sort | Nick Andrews |
| collection | DOAJ |
| description | Objectives To investigate the safety of live attenuated varicella zoster vaccination when administered to immunosuppressed individuals.Design Prospective observational cohort study.Setting The study used anonymised data from the Clinical Practice Research Datalink (CPRD), comprising a representative sample of routinely collected primary care data in England between 2013 and 2017 and and linked Hospital Episode Statistics data.Participants 168 767 individuals age-eligible for varicella zoster vaccination registered at a general practice in England contributing data to CPRD.Main outcome measures Electronic health records indicating immunosuppression, zoster vaccination, diagnoses of specific varicella-zoster virus (VZV)-related disease and non-specific rash/encephalitis compatible with VZV-related disease.Results Between 1 September 2013 and 31 August 2017, a period of immunosuppression was identified for 9093/168 767 (5.4%; 95% CI: 5.3%–5.5%) individuals age-eligible for zoster vaccination. The overall rate of vaccination while immunosuppressed was 1742/5251 (33.2 per 100 adjusted person years at risk; 95% CI: 31.9%–34.5%). Follow-up of the 1742 individuals who were inadvertently vaccinated while immunosuppressed identified only two cases of VZV-related disease within 8 weeks of vaccination (0.1%; 95% CI: 0.01%–0.4%), both primary care diagnoses of ‘shingles’, neither with a related hospital admission.Conclusions Despite evidence of inadvertent vaccination of immunosuppressed individuals with live zoster vaccination, there is a lack of evidence of severe consequences including hospitalisation. This should reassure primary care staff and encourage vaccination of mildly immunosuppressed individuals who do not meet current thresholds for contraindication. These findings support a review of the extent to which live zoster vaccination is contraindicated among the immunosuppressed. |
| format | Article |
| id | doaj-art-152230b286e042439cf24e07fc32fb94 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-152230b286e042439cf24e07fc32fb942025-08-20T02:31:08ZengBMJ Publishing GroupBMJ Open2044-60552020-01-0110110.1136/bmjopen-2019-034886Safety of inadvertent administration of live zoster vaccine to immunosuppressed individuals in a UK-based observational cohort analysisNick Andrews0Sara Thomas1Daniel J Grint2Helen I McDonald3Jemma L Walker4Gayatri Amirthalingam5Immunisation and Countermeasures Division, Public Health England, London, UKCwm Taf Public Health Team, Public Health Wales, Public Health Wales, Merthyr Tydfil, UK1 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UKFaculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UKFaculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UKUK Health Security Agency, London, UKObjectives To investigate the safety of live attenuated varicella zoster vaccination when administered to immunosuppressed individuals.Design Prospective observational cohort study.Setting The study used anonymised data from the Clinical Practice Research Datalink (CPRD), comprising a representative sample of routinely collected primary care data in England between 2013 and 2017 and and linked Hospital Episode Statistics data.Participants 168 767 individuals age-eligible for varicella zoster vaccination registered at a general practice in England contributing data to CPRD.Main outcome measures Electronic health records indicating immunosuppression, zoster vaccination, diagnoses of specific varicella-zoster virus (VZV)-related disease and non-specific rash/encephalitis compatible with VZV-related disease.Results Between 1 September 2013 and 31 August 2017, a period of immunosuppression was identified for 9093/168 767 (5.4%; 95% CI: 5.3%–5.5%) individuals age-eligible for zoster vaccination. The overall rate of vaccination while immunosuppressed was 1742/5251 (33.2 per 100 adjusted person years at risk; 95% CI: 31.9%–34.5%). Follow-up of the 1742 individuals who were inadvertently vaccinated while immunosuppressed identified only two cases of VZV-related disease within 8 weeks of vaccination (0.1%; 95% CI: 0.01%–0.4%), both primary care diagnoses of ‘shingles’, neither with a related hospital admission.Conclusions Despite evidence of inadvertent vaccination of immunosuppressed individuals with live zoster vaccination, there is a lack of evidence of severe consequences including hospitalisation. This should reassure primary care staff and encourage vaccination of mildly immunosuppressed individuals who do not meet current thresholds for contraindication. These findings support a review of the extent to which live zoster vaccination is contraindicated among the immunosuppressed.https://bmjopen.bmj.com/content/10/1/e034886.full |
| spellingShingle | Nick Andrews Sara Thomas Daniel J Grint Helen I McDonald Jemma L Walker Gayatri Amirthalingam Safety of inadvertent administration of live zoster vaccine to immunosuppressed individuals in a UK-based observational cohort analysis BMJ Open |
| title | Safety of inadvertent administration of live zoster vaccine to immunosuppressed individuals in a UK-based observational cohort analysis |
| title_full | Safety of inadvertent administration of live zoster vaccine to immunosuppressed individuals in a UK-based observational cohort analysis |
| title_fullStr | Safety of inadvertent administration of live zoster vaccine to immunosuppressed individuals in a UK-based observational cohort analysis |
| title_full_unstemmed | Safety of inadvertent administration of live zoster vaccine to immunosuppressed individuals in a UK-based observational cohort analysis |
| title_short | Safety of inadvertent administration of live zoster vaccine to immunosuppressed individuals in a UK-based observational cohort analysis |
| title_sort | safety of inadvertent administration of live zoster vaccine to immunosuppressed individuals in a uk based observational cohort analysis |
| url | https://bmjopen.bmj.com/content/10/1/e034886.full |
| work_keys_str_mv | AT nickandrews safetyofinadvertentadministrationoflivezostervaccinetoimmunosuppressedindividualsinaukbasedobservationalcohortanalysis AT sarathomas safetyofinadvertentadministrationoflivezostervaccinetoimmunosuppressedindividualsinaukbasedobservationalcohortanalysis AT danieljgrint safetyofinadvertentadministrationoflivezostervaccinetoimmunosuppressedindividualsinaukbasedobservationalcohortanalysis AT helenimcdonald safetyofinadvertentadministrationoflivezostervaccinetoimmunosuppressedindividualsinaukbasedobservationalcohortanalysis AT jemmalwalker safetyofinadvertentadministrationoflivezostervaccinetoimmunosuppressedindividualsinaukbasedobservationalcohortanalysis AT gayatriamirthalingam safetyofinadvertentadministrationoflivezostervaccinetoimmunosuppressedindividualsinaukbasedobservationalcohortanalysis |