Possible contraindications for herpes zoster vaccination in immunocompromised patients
| REASON FOR IMMUNODEFICIENCY | CAN THE VACCINE BE CONSIDERED IN THIS GROUP? |
|---|---|
| Bone marrow or lymphatic cancers (including leukemias and lymphomas) | No |
| Leukemia in remission and no radiotherapy or chemotherapy for at least 3 months | Yes |
| AIDS or manifestations of HIV (including CD4-positive T lymphocyte counts of less than 200/mm3 or less than 15% of the total lymphocyte count) | No |
| Prednisone (or an equivalent corticosteroid): 20 mg/d or more for 2 or more weeks | No |
| Prednisone (or equivalent corticosteroid): less than 20 mg/d and not as chronic daily therapy* | Yes |
| Topical, intranasal, inhaled, and intra-articular corticosteroid use | Yes |
| Bursal or tendon corticosteroid injections | Yes |
| Methotrexate: more than 0.4 mg/kg weekly | No |
| Azathioprine: more than 3 mg/kg weekly | No |
| Mercaptopurine: more than 1.5 mg/kg weekly | No |
| Evidence (laboratory or clinical) of cellular immune deficiency | No |
| Impaired humoural immunity (eg, dysgammaglobulinemia, hypogammaglobulinemia) | Yes |
| Planned hematopoietic stem cell transplantation | Limited evidence—assess patient-relevant risk |
| 2 or more years post–hematopoietic stem cell transplantation | Yes |
| Recombinant human immune mediators and immune modulators, particularly tumour necrosis factor inhibitors; the ACIP recommends deferring vaccination for at least 1 month after discontinuation of these therapies | No |
ACIP—Advisory Committee on Immunization Practices, CD—cluster of differentiation.
↵* A clinical trial is under way to assess vaccination in individuals 60 years of age or older who are taking 5 to 20 mg of prednisone daily.23
Data from Harpaz et al.11