Shingles in cancer patients: who is most at risk?

By Jane Lewis
Among patients with cancer, those with haematological cancers are at highest risk of developing herpes zoster (HZ), reports an Australian study in the Journal of Infectious Diseases. In patients with solid cancers, the risk of HZ is significantly higher among those receiving chemotherapy, the study also found.

‘GPs are familiar with the concept that people with cancer are more at risk of shingles. However, this new study pro­vides much needed data on differences in risk associated with different types of cancer, and the receipt of cancer treat­ment itself,’ commented Pro­fessor Kristine Macartney, Director of the National Centre for Immunisation Research and Surveillance, and one of the study authors.

The research, based on data from the 45 and Up Study and involving 241,497 adults (mean age, 62 years) followed for more than eight years (1,760,481 person­-years), found that people diagnosed with cancer had a significantly higher risk of HZ than those without cancer (adjusted hazard ratio [aHR], 1.41). The risk was highest in the first year after diagnosis. Compared with people without cancer, those with haematolo­gical cancer had a substantially higher risk of HZ than those with solid cancers (aHR, 3.74 vs 1.30, respectively). Among people with solid cancers, those receiving chemotherapy had a higher HZ risk than those who did not (aHR, 1.83 vs 1.16, respectively).

For patients with haematolo­gical cancer, an increased risk of HZ was apparent in the two years preceding diagnosis, a finding Professor Macartney described as intriguing and one that might implicate immune dysfunction occurring before the cancer diagnosis, resulting in virus reactivation causing HZ.

The authors of an accomp­anying editorial said the study’s findings had important implica­tions in view of recent advances in HZ vaccine development. Both the HZ subunit adjuvanted vaccine (HZ/su) recently approved by the US FDA and an inactivated vaccine currently in development ‘appear to offer great promise in preventing HZ and its complications in patients with cancer,’ they wrote.

Professor Macartney noted that although the HZ vaccine currently available in Australia is contraindicated in people with cancer, it becomes free at 70 years of age under the National Immunisation Program. ‘While we cannot currently vaccinate people with cancer, we can improve vaccine uptake in older people, who risk developing can­cer in the future,’ she advised. HZ/su, recently licensed but not yet available in Australia, ‘holds much promise for use in patients with cancer, hopefully in the not­ too­ distant future’, she added.
J Infect Dis 2018; doi: 10.1093/infdis/jiy625.
J Infect Dis 2018; doi: 10.1093/infdis/jiy626.