By IDSE News Staff 

People newly diagnosed with cancer, particularly hematologic cancers, and those treated with chemotherapy have a greater risk for developing shingles (J Infect Dis 2018 Dec 13. [Epub ahead of print]).

The large prospective study expands on previous research by examining the risk for shingles before and after a new cancer diagnosis and across a range of cancer types among approximately 240,000 adults in Australia, from 2006 to 2015.

In the study, researchers found that overall, a cancer diagnosis of any kind was associated with about a 40% increase in risk for developing shingles compared with the risk in someone without cancer. Patients with a hematologic cancer diagnosis had a more than threefold higher risk for shingles than people without cancer. Individuals with a diagnosis of cancer related to a solid tumor had a 30% higher shingles risk than someone without cancer.

Shingles, or herpes zoster, is caused by the varicella zoster virus, the same virus that causes chickenpox. Shingles develops when the virus, which remains dormant in the body, reactivates later in life. Nearly one in three people in the United States will develop shingles in their lifetime, and there are an estimated 1 million cases in the country each year, according to the CDC.

The new analysis also found that the higher risk for shingles among patients with blood cancers was present in the two years before their cancer diagnosis, according to the study’s first author, Jiahui Qian, MPH, of the University of New South Wales in Sydney, Australia. However, for patients with solid tumors, the higher risk for shingles appeared to be largely associated with receiving chemotherapy after their diagnosis, rather than with the cancer itself. In examining the higher risk for shingles in cancer patients, few previous studies have separated the risk for shingles associated with a patient’s cancer from the risk associated with chemotherapy.

“These findings have important implications in view of recent advances in development of zoster vaccines,” wrote Kosuke Kawai, ScD, of Boston Children’s Hospital and Harvard Medical School in Boston, and Barbara P. Yawn, MD, MSc, of the University of Minnesota, in Minneapolis, in a related editorial commentary that appears in the same journal.

A new shingles vaccine approved for use in the United States in 2017 does not use a live form of the virus and is likely to be safer in people with compromised immune systems, such as patients on chemotherapy, according to the Infectious Diseases Society of America. The vaccine is not yet recommended for these individuals in this country, as public health officials await more data on the vaccine’s use in such patients. 

Another new shingles vaccine that uses an inactivated form of the virus is in development. These advances indicate that vaccination holds great promise as a strategy to prevent shingles and its complications in cancer patients, according to both the commentary and study authors.