Do you recommend shingles vaccine to all immunosuppressed patients under the age of 50 y.o.?

This is an interesting question. Clearly, patients with autoimmune or immune-mediated diseases because of their immunosuppressed status are at an increased risk of H. zoster, regardless of age. Presently, the recommendations from the CDC, different professional societies, etc., are to immunize patients over the age of 50 years, using the recombinant killed virus vaccine (Shingrix). I believe the older live attenuated vaccine (Zostavax) is no longer available in this country. At any rate, I have a few patients with autoimmune diseases who have been immunized with Shingrix who are below the age of 50 years. I believe that there is nothing inherently wrong with immunizing these younger patients especially if they are receiving JAK inhibitors, ...