Wasan Sharmeel K, Zullow Samantha, Berg Adam, Cheifetz Adam S, Ganley-Leal Lisa, Farraye Francis A
Departments of *Gastroenterology and †Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; ‡Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and §Department of Infectious Diseases, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
Inflamm Bowel Dis. 2016 Jun;22(6):1391-6. doi: 10.1097/MIB.0000000000000743.
Inflammatory Bowel Disease (IBD) patients are at an increased risk of developing herpes zoster (HZ), especially when immunosuppressed. HZ may be preventable with the herpes zoster vaccine (HZV), but many patients are not offered vaccination over concern regarding efficacy and fear of adverse events. Although the Center for Disease Control and Prevention recommends that low-dose immunosuppression is not a contraindication, few IBD patients on these medications are receiving HZV.
This study was a prospective clinical trial to assess the safety and immunogenicity of HZV among 2 groups of IBD patients. Group A consisted of 14 patients on low-dose immunomodulators and group B consisted of 25 patients either on 5-aminosalicylic acid or no IBD therapy. Blood samples were obtained to measure immune responses.
HZ specific immunoglobulin G rose significantly in both groups but the response was lower in the immunosuppressed group (P = 0.0002). Peripheral blood mononuclear cell secretion of Tumor necrosis factor-α in response to HZ antigen increased after HZV in group B, but not in group A. Interleukin-8 secretion increased in both groups, but the response was much higher in group B. There were no significant differences in adverse events between groups. No patients developed a HZ-like rash within 1 year after vaccination.
IBD patients on low-dose immunosuppressive therapy have a blunted immune response to HZV as compared with nonimmunosuppressed subjects. Despite this, immunosuppressed IBD patients are able to mount a statistically significant immune response. There were no serious adverse events to HZV.
炎症性肠病（IBD）患者发生带状疱疹（HZ）的风险增加，尤其是在免疫抑制状态下。带状疱疹疫苗（HZV）可能预防HZ，但许多患者因担心疗效和害怕不良事件而未接种疫苗。尽管疾病控制与预防中心建议低剂量免疫抑制并非接种禁忌，但很少有服用这些药物的IBD患者接种HZV。
本研究是一项前瞻性临床试验，旨在评估HZV在两组IBD患者中的安全性和免疫原性。A组由14名服用低剂量免疫调节剂的患者组成，B组由25名服用5-氨基水杨酸或未接受IBD治疗的患者组成。采集血样以测量免疫反应。
两组中针对HZ的特异性免疫球蛋白G均显著升高，但免疫抑制组的反应较低（P = 0.0002）。B组接种HZV后，外周血单个核细胞对HZ抗原的肿瘤坏死因子-α分泌增加，而A组未增加。两组白细胞介素-8分泌均增加，但B组的反应更高。两组间不良事件无显著差异。接种疫苗后1年内无患者出现HZ样皮疹。
与未免疫抑制的受试者相比，接受低剂量免疫抑制治疗的IBD患者对HZV的免疫反应减弱。尽管如此，免疫抑制的IBD患者仍能产生具有统计学意义的免疫反应。HZV未出现严重不良事件。
