{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T19:44:42Z","timestamp":1765827882781,"version":"build-2065373602"},"reference-count":18,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,1,29]],"date-time":"2020-01-29T00:00:00Z","timestamp":1580256000000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["Health Protection Research Unit in Immunisation"],"award-info":[{"award-number":["Health Protection Research Unit in Immunisation"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,1,7]]},"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To investigate the safety of live attenuated varicella zoster vaccination when administered to immunosuppressed individuals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Prospective observational cohort study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>168\u2009767 individuals age-eligible for varicella zoster vaccination registered at a general practice in England contributing data to CPRD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measures<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Between 1 September 2013 and 31 August 2017, a period of immunosuppression was identified for 9093\/168 767 (5.4%; 95%\u2009CI: 5.3%\u20135.5%) 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%\u2009CI: 31.9%\u201334.5%). 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%\u2009CI: 0.01%\u20130.4%), both primary care diagnoses of \u2018shingles\u2019, neither with a related hospital admission.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-034886","type":"journal-article","created":{"date-parts":[[2020,1,30]],"date-time":"2020-01-30T05:06:20Z","timestamp":1580360780000},"page":"e034886","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Safety of inadvertent administration of live zoster vaccine to immunosuppressed individuals in a UK-based observational cohort analysis"],"prefix":"10.1136","volume":"10","author":[{"given":"Daniel J","family":"Grint","sequence":"first","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0576-2015","authenticated-orcid":false,"given":"Helen I","family":"McDonald","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jemma L","family":"Walker","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK"},{"name":"Statistics, Modelling and Economics Department, Public Health England, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gayatri","family":"Amirthalingam","sequence":"additional","affiliation":[{"name":"Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nick","family":"Andrews","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK"},{"name":"Statistics, Modelling and Economics Department, Public Health England, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,1,29]]},"reference":[{"key":"2025101814201437000_10.1.e034886.1","unstructured":"Public Health England . Immunisation against infectious disease (the green book). Chapter 28a: shingles (herpes zoster), 2016. Available: https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/503773\/2905109_Green_Book_Chapter_28a_v3_0W.PDF"},{"key":"2025101814201437000_10.1.e034886.2","doi-asserted-by":"crossref","first-page":"e82","DOI":"10.1016\/S2468-2667(17)30234-7","article-title":"Evaluation of the effect of the herpes zoster vaccination programme 3 years after its introduction in England: a population-based study","volume":"3","author":"Amirthalingam","year":"2018","journal-title":"Lancet Public Health"},{"key":"2025101814201437000_10.1.e034886.3","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-020528","article-title":"Burden of herpes zoster in 16 selected immunocompromised populations in England: a cohort study in the clinical practice research Datalink 2000-2012","volume":"8","author":"Yanni","year":"2018","journal-title":"BMJ Open"},{"key":"2025101814201437000_10.1.e034886.4","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1212\/WNL.0000000000002808","article-title":"Quantification of risk factors for postherpetic neuralgia in herpes zoster patients: a cohort study","volume":"87","author":"Forbes","year":"2016","journal-title":"Neurology"},{"key":"2025101814201437000_10.1.e034886.5","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu501"},{"key":"2025101814201437000_10.1.e034886.6","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2015-212688","article-title":"Fatal disseminated varicella zoster infection following zoster vaccination in an immunocompromised patient","volume":"2016","author":"Costa","year":"2016","journal-title":"BMJ Case Rep"},{"key":"2025101814201437000_10.1.e034886.7","doi-asserted-by":"crossref","first-page":"3890","DOI":"10.1016\/j.vaccine.2018.05.078","article-title":"Live zoster vaccination in an immunocompromised patient leading to death secondary to disseminated varicella zoster virus infection","volume":"36","author":"Alexander","year":"2018","journal-title":"Vaccine"},{"key":"2025101814201437000_10.1.e034886.8","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1001\/jama.2019.9053","article-title":"Effect of recombinant zoster vaccine on incidence of herpes zoster after autologous stem cell transplantation: a randomized clinical trial","volume":"322","author":"Bastidas","year":"2019","journal-title":"JAMA"},{"key":"2025101814201437000_10.1.e034886.9","doi-asserted-by":"crossref","first-page":"2371","DOI":"10.1016\/j.vaccine.2018.02.021","article-title":"Effectiveness of herpes zoster vaccination in an older United Kingdom population","volume":"36","author":"Walker","year":"2018","journal-title":"Vaccine"},{"key":"2025101814201437000_10.1.e034886.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2008.11.077"},{"key":"2025101814201437000_10.1.e034886.11","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1111\/bjd.16399","article-title":"Inequalities in zoster disease burden: a population-based cohort study to identify social determinants using linked data from the U.K. clinical practice research Datalink","volume":"178","author":"Jain","year":"2018","journal-title":"Br J Dermatol"},{"key":"2025101814201437000_10.1.e034886.12","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.7304"},{"key":"2025101814201437000_10.1.e034886.13","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1016\/j.mayocp.2015.04.021","article-title":"Risk of herpes zoster and disseminated varicella zoster in patients taking immunosuppressant drugs at the time of zoster vaccination","volume":"90","author":"Cheetham","year":"2015","journal-title":"Mayo Clin Proc"},{"key":"2025101814201437000_10.1.e034886.14","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.22196"},{"key":"2025101814201437000_10.1.e034886.15","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu498"},{"key":"2025101814201437000_10.1.e034886.16","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001420","article-title":"Herpes zoster vaccine effectiveness against incident herpes zoster and post-herpetic neuralgia in an older US population: a cohort study","volume":"10","author":"Langan","year":"2013","journal-title":"PLoS Med"},{"key":"2025101814201437000_10.1.e034886.17","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1093\/cid\/ciy242","article-title":"Safety and Immunogenicity of Zoster Vaccine Live in Human Immunodeficiency Virus-Infected Adults With CD4+ Cell Counts >200 Cells\/mL Virologically Suppressed on Antiretroviral Therapy","volume":"67","author":"Benson","year":"2018","journal-title":"Clin Infect Dis"},{"key":"2025101814201437000_10.1.e034886.18","unstructured":"Public Health England . Herpes zoster (shingles) immunisation programme 2017 to 2018: evaluation report health protection report, 2018."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2019-034886","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T21:20:24Z","timestamp":1760822424000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2019-034886"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,1,29]]},"published-print":{"date-parts":[[2020,1]]}},"alternative-id":["10.1136\/bmjopen-2019-034886"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2019-034886","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2020,1]]}}}