A Small but Positive Change in recommendations about the Zoster Vaccine

In November of 2008, I helped launch a campaign that eventually involved Drs. Hamblin and Furman and others in changing the recommendations of the Advisory Committee on Immunization Practices (ACIP) about who should not get the live Zoster (shingles) vaccine.

Their recommndations used to read (in part):

• Persons with leukemia, lymphomas, or other malignant neoplasms affecting the bone marrow or lymphatic system. However, patients whose leukemia is in remission and who have not received chemotherapy (e.g., alkylating drugs or antimetabolites) or radiation for at least 3 months can receive zoster vaccine.

Now they read (in part):

Who should NOT get the shingles vaccine? NEW MAY 2009

Some people should not get the shingles vaccine:

• People with a weakened immune system as a result of leukemia, lymphoma, or any other blood or bone cancer.
• People being treated with drugs that affect the immune system, including high-dose steroids.

Please notice that there is no longer the three months clean and you are cleared for vaccination. This is a subtle, but important change that better reflects the present state of knowledge about live attenuated vaccine safety for people like me.

The new recommendations happened quietly, so quietly that I missed the change, but I think the CLL community can feel proud about the role we played in nudging the infectious disease and hematology communities out of their silos and closer together in their thinking about how to best serve some of their most vulnerable patients.

Thanks to all those who helped, especially Dr. Hamblin.

This is good news.