The American College of Rheumatology (ACR) has released a Hotline detailing the CDC recommendations.
The recommendations continue to discourage use of the vaccine in patients receiving biologics, those receiving high dose daily prednisone (> 20 mg per day), and those with cellular immunodeficiency (i.e. hypogammaglobulinemia). However, consideration for giving the vaccine can be made for those receiving low dose prednisone, azathioprine, and methotrexate (< 0.4 mg/kg/week). The ACR suggests administering the vaccine at least two weeks prior to the initiation of a biologic DMARD in those appropriate for the vaccine (i.e. age greater than 60 years). The FDA is collecting all reports on suspected incident shingles thought to be vaccine related in these patients. Thus, any such suspected cases should be reported to the FDA’s Medwatch passive surveillance system.