2023-08-21 07:37:50
The risk of developing shingles is 29% higher than the general population…”Restriction on live vaccines, preferentially recommending inactivated vaccines”
Enter 2023.08.21 16:37 Hits 3 Enter 2023.08.21 16:37 Hits 3
Shingles is a chronic disease with severe pain, and prevention and management are important. [사진=게티이미지뱅크]
The importance of vaccination for psoriasis patients at high risk of developing shingles is being emphasized.
In the meantime, in psoriasis patients receiving systemic immunosuppressant treatment, the use of live vaccines has been classified as ‘contraindicated’ and vaccination has been restricted. However, with the introduction of a genetically recombinant killed vaccine that solves these problems, a major change is expected in the prevention strategy of shingles.
Psoriasis is a chronic skin disease in which erythema and white scaly keratin appear on the skin and joints due to an abnormal immune system. It is estimated that there are regarding 1.5 million psoriasis patients in Korea, and the prevalence rate is steadily increasing at 3%.
Above all, psoriasis repeats exacerbation and improvement of symptoms. As a result, patients suffer from physical and mental pain due to skin lesions, as well as significantly adversely affect their quality of life. In addition, special attention is required as it can accompany various complications such as psoriatic arthritis, cardiovascular disease, malignant tumor, and depression that require long-term treatment.
The problem here is that when these psoriasis patients receive biologic treatment known as standard therapy, the risk of developing shingles increases.
According to the results of a retrospective cohort analysis using Taiwanese National Health Insurance data, patients with psoriasis had a 29% higher risk of developing shingles compared to patients without psoriasis. Furthermore, the risk of developing severe psoriasis increased by 61%.
In fact, clinical evidence is accumulating that biological agents used to treat psoriasis that suppress the immune response increase a patient’s risk of developing shingles. A study led by the UCLA School of Medicine in the United States also showed an increased risk of developing herpes zoster in patients who used the biologic drug ‘infliximab’.
Accordingly, there is also an opinion that patients using biological agents such as infliximab should consider vaccination before starting drug administration.
The number of people who use immunosuppressants, live vaccine ‘contraindicated’… Academia “recommendation of Shingrix, a dead vaccine”
Shingles is caused by reactivation of the varicella-zoster virus (VZV) dormant in the body when the immune system is weakened. In general, painful blisters are observed in the form of a rash on the chest, abdomen, and face. The pain is often expressed as a tingling, burning or stinging sensation.
In particular, care is needed as complications such as postherpetic neuralgia (PHN), which continue to cause pain even following the rash disappears, can last for at least one month and up to several years.
However, many psoriasis patients, for whom shingles prevention is important, have had a lot of difficulty getting the vaccine. This is because shingles vaccine (live vaccine) is restricted for psoriasis patients receiving systemic immunosuppressant treatment.
In fact, live vaccines are classified as inoculation contraindications for patients with congenital or acquired immunodeficiency or receiving immunosuppressive therapy including high-dose steroids.
Even in this vaccination atmosphere, changes began to occur. Shingrix, an inactivated vaccine, was released in Korea in December of last year, making it possible to vaccinate once morest shingles for immunocompromised patients who were contraindicated for live vaccines.
Shingrix, injected twice intramuscularly, is Korea’s first gene recombination target that combines ‘glycoprotein E’, a protein component of the varicella-zoster virus, and ‘AS01B’, an immune enhancer that enhances the immune response to antigens. It is evaluated as a herpes vaccine. It is possible to inoculate not only adults over the age of 50, but also people over the age of 18 who are at high risk of developing shingles due to immunosuppression or immunosuppression due to disease or treatment.
Current academic shingles vaccination guidelines also actively reflect this. The American Academy of Dermatology recommends inoculation with the vaccine for all psoriasis and psoriatic arthritis (PsA) patients over the age of 50, as well as patients under the age of 50 who are using the JAK inhibitor tofacitinib and systemic steroid therapy.
Furthermore, the US Advisory Committee on Immunization Advisory Committee (ACIP), through its 2021 guidelines, first recommended two doses of Shingrix for immunocompromised patients over the age of 19.
“The risk of developing herpes zoster in psoriasis patients can be increased by biologic treatment,” said Nam Hyeon-min (dermatology), head of the Severe Psoriasis/Atopy Center at Daejain Hospital in Jeonju. It is a situation classified as a contraindication to administration to patients with psoriasis and psoriatic arthritis who are taking it.”
He said, “Since these problems have been resolved with the recent introduction of the inactivated vaccine Shingrix, it is recommended that many psoriasis patients, for whom prevention of shingles is important, consult with medical staff and actively receive vaccination.”
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