INTRODUCTION: Zostavax, a live attenuated vaccine, has been approved in the 
United States for use in older individuals to reduce the risk and severity of 
herpes zoster (HZ), also known as shingles. The vaccine is contraindicated in 
individuals taking anti-tumor necrosis factor alpha (anti-TNF) therapies or 
other biologics commonly used to treat autoimmune diseases because of the safety 
concern that zoster vaccine may be associated with a short-term HZ risk. The 
objective of the study was to examine the use, safety (short-term HZ risk after 
vaccination), and effectiveness of zoster vaccine in individuals with rheumatoid 
arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, and/or 
inflammatory bowel diseases.
METHODS: We conducted a cohort study of patients aged 50 years and older with 
rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, 
and/or inflammatory bowel diseases by using administrative claims data from a 
nationwide health plan from January 1, 2005, to August 31, 2009. We examined the 
extent to which zoster vaccine was used; assessed factors associated with 
vaccine use (Cox proportional hazards regression); and compared the incidence 
rates of herpes zoster (HZ) between vaccinated and unvaccinated patients.
RESULTS: Among 44,115 patients with the autoimmune diseases, 551 (1.2%) received 
zoster vaccine, and 761 developed HZ. Zoster vaccine use increased continuously 
after approval in 2006. Younger and healthier patients, those who had an HZ 
infection within the past 6 months, and those who were not using anti-TNF 
therapies were more likely to receive the vaccine. Approximately 6% of 
vaccinated patients were using anti-TNF therapies at the time of vaccination. 
The incidence rates of HZ were similar in vaccinated and unvaccinated patients 
(standardized incidence ratio, 0.99; 95% confidence interval, 0.29 to 3.43).
CONCLUSIONS: Use of the zoster vaccine was uncommon among older patients with 
autoimmune diseases, including those not exposed to immunosuppressive 
medications. The short-term risk of HZ did not appear to be increased in 
vaccinated patients, even among those using immunosuppressive therapies (for 
example, biologics) at the time of vaccination. However, our study was limited 
by the small number of vaccinated patients, and further evidence is needed to 
confirm the vaccine's safety and efficacy in this population.