Dose Route Of Administration And Schedule
Live attenuated zoster vaccine
Each dose is 0.65 mL .
Route of administration
Each dose is 0.5 mL .
Route of administration
Intramuscular, into the deltoid region of the upper arm.
Administration of the RZV as a subcutaneous injection is a vaccine administration error and should be avoided. However, if Shingrix is inadvertently administered subcutaneously, that dose will be considered as valid in the vaccine series. The second dose will be given as per vaccine schedule.
For more information, refer to Vaccine Administration Practices in Part 1.
2 doses, 2 to 6 months apart. A 0,12 months schedule may be considered for improved adherence to the 2nd dose .
Providers should consider different strategies to promote adherence to the two dose schedule for RZV .
New More Effective Shingles Vaccine Offers Greater Protection
A vaccine against shingles has been available for several years, but a new vaccine promises to offer greater protection and significantly limit the suffering from shingles. Approved by the Food and Drug Administration last October, the Shingrix vaccine provides a 90 percent protection rate for older adults, compared with 50 percent for the previously available Zostavax vaccine. And unlike its predecessor, Shingrix can safely be given to those with compromised immune systems.Close to one-in-three Americans will develop shingles, a rash of itchy blisters similar but more painful than chicken pox. Usually appearing in a swath on the side of the face or torso, shingles feels, as one sufferer described it, like being pressed against a cactus.
The old vaccine is a live vaccine, says Daniel Z. Uslan, MD, an infectious diseases physician and director of the UCLA Antimicrobial Stewardship Program. It makes your body immune by exposing it to a live but weakened shingles virus. The new vaccine is an inactivated recombinant vaccine, meaning there is no live virus in it. Its a much safer vaccine that we can use in patients with weaker immune systems. And those are the people who need the vaccine because theyre most likely to get shingles and have complications from shingles.
Where Can You Get It
Shingrix is available at most pharmacies, doctors offices and clinics throughout the country but can also be administered through pharmacies that offer flu vaccinations as well as health departments in select states.
Shingrix is given as a two-dose series, with the second shot administered two to six months after the first injection.
However, if you have a severe allergy to any ingredients that might be included in the shots then its best not to visit your pharmacy since they may not know what is being used as an ingredient within their own products. Every person should discuss with their physician where they would feel most comfortable receiving shingles vaccinations.
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Herpes Zoster Vaccine: Canadian Immunization Guide
For health professionals
Last complete revision:
July 2018 This chapter was revised to reflect NACI’s Updated Recommendations on the Use of Herpes Zoster Vaccines. Most sections were revised to include information and practice recommendations for the new recombinant zoster vaccine which is now available in Canada. Changes include:
- Recommendations for use in different populations.
- Contraindications and precautions.
- Administration of the HZ vaccines: Table 1 was added to summarize key information.
- Considerations on the efficacy, effectiveness and immunogenicity of HZ vaccines: Table 2 was added to summarize key information.
- Vaccine safety and adverse events.
Guidance On Reporting Adverse Events Following Immunization
Vaccine providers are asked to report AEFIs through local public health officials and to follow AEFI reporting requirements that are specific to their province or territory. In general, any serious or unexpected adverse event felt to be temporally related to vaccination should be reported.
For LZV the following AEFIs are also of particular interest and should be reported:
- Suspected transmission of vaccine-strain virus to a close household or occupational contact. This phenomenon has been documented following varicella vaccine but it is rare, and transmission has not been documented with LZV.
- Recurrent HZ following immunization of individuals with a history of HZ prior to immunization, noting the area of recurrence.
- Recurrent HZO following immunization of a person who has had a previous episode of HZO. If available, a vitreous fluid specimen should be sent to a laboratory with a request to determine whether the virus is the vaccine strain or wild type virus.
For definitions of serious and unexpected adverse events, refer to Adverse events following immunization in Part 2.
For more information refer to Reporting Adverse Events Following Immunization in Canada.
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Who’s Most At Risk Of Shingles
People tend to get shingles more often as they get older, especially over the age of 70. And the older you are, the worse it can be. The shingles rash can be extremely painful, such that sufferers cannot even bear the feeling of their clothes touching the affected skin.
The pain of shingles can also linger long after the rash has disappeared, even for many years. This lingering pain is called post-herpetic neuralgia .
Live Shingles Vaccine Vs Non
A live vaccine is one that contains a weakened form of a germ. Shingrix is not a live vaccine. Its an inactive vaccine, which is a vaccine thats made from a germ thats been killed.
Because Shingrix is inactive, more people can receive it. This includes people with a weakened immune system .
Zostavax was a shingles vaccine that was live.
People with weakened immune systems are typically advised against receiving live vaccines. This is because on very rare occasions, live vaccines can mutate back to the full-strength germ that causes a disease. If this happens, people with weakened immune systems would have a much higher risk for developing the disease that the vaccine is meant to prevent.
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If Youre 50 Or Older Get Shingrix
- Shingrix provides strong protection from shingles and long-term nerve pain.
- Get Shingrix even if you already had shingles, because you can get the disease more than once.
- Your risk of shingles and complications increases as you age.
- You need 2 doses of Shingrix. Get the second dose 2 to 6 months after you get the first dose.
Why A New Shingles Vaccine
Did we need a new shingles vaccine? To answer that question, it helps to have a bit of background on this infection.
Shingles, which is also called herpes zoster, occurs when the chickenpox virus , which is dormant in those whove had the illness, reawakens later in life. Almost all adults older than 40 carry the chickenpox virusand the older we get, the more the risk of getting shingles climbs. According to the CDC, the infection strikes about 1 million people in the U.S. each year and nearly one in three adults will experience a bout of shingles in their lifetime.
The two to four weeks of shingles, marked by symptoms such as a blistery and painful rash on one side of the body, can be difficult enough. But about one in five people with shingles go on to develop postherpetic neuralgia, or PHN, which is nerve pain that can linger for months or even years.
Since 2006, weve had Zostavaxapproved for those between 50 and 59 but recommended by the CDC for adults 60 and olderas the sole bulwark against shingles. Zostavax offers 70 percent protection against shingles for people between 50 and 59 but only 18 percent in people 80 and older, according to the Pink Sheet, which reports on the pharmaceutical industry.
When all ages are taken into consideration, Zostavax cuts the chance of shingles by only 51 percent and the risk of PHN by 67 percent.
Shingles is a big problem with immunocompromised people, Schaffner says.
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Dosage For Shingles Prevention
Shingrix is given as two 0.5-mL injections in your upper arm. Youll receive two doses of this vaccine.
Over time, some vaccines protection begins to fade, so may you need booster doses. They help keep the vaccine working. But you dont need a booster dose after getting the two doses of Shingrix.
Shingrix dosing schedule for people ages 50 years and older
For people ages 50 years and older taking Shingrix, the second dose is given 2 to 6 months after the first dose.
Shingrix dosing schedule for people ages 18 years and older with an increased risk of shingles
For people ages 18 years and older with an increased risk of shingles who are taking Shingrix, the second dose may be given 1 to 2 months after the first dose.
Cost And Formulary Considerations
Herpes zoster is associated with significant economic and public health costs in the U.S. A 2016 cost analysis estimated the annual direct and indirect costs related to herpes zoster as $782 million. In addition, the projected cost of herpes zoster in people 65 years and older will be $4.74 billion by 2030. includes a cost comparison between HZ/su and ZVL. The average wholesale price of each Hz/su dose is $173, with a total cost of $346. Unlike influenza and pneumococcal vaccines, which are covered by Medicare Part B, herpes zoster vaccines are covered under Medicare Part D, which may present an economic challenge for many Medicare recipients.
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Mayo Clinic Q And A: New Shingles Vaccine Recommended For Most Adults Over Age 50
DEAR MAYO CLINIC: How effective is the shingles vaccine? Who should get it? Is it recommended even for those who have already had shingles?
ANSWER: A new vaccine, called Shingrix, is now available thats very effective in preventing shingles. The Centers for Disease Control and Prevention recommends that everyone age 50 and older with a healthy immune system receive this vaccine, whether youve had shingles before or not.
Unlike the other vaccine thats been available for shingles since 2006, called Zostavax, this new vaccine is inactivated. That means it does not contain a live virus. Because of that, it is safe in people who have weakened immune systems. However, the CDC has not yet made recommendations for Shingrix vaccination in these individuals. If you have a weakened immune system, talk to your health care provider about your vaccination options for shingles.
Shingles is caused by a virus called varicella-zoster. When youre first infected with this virus, it causes the itchy rash known as chickenpox. Although chickenpox is uncomfortable, most people recover from it without any lasting problems. But after the rash of chickenpox goes away, the virus does not. Instead, the varicella-zoster virus goes into hiding in your bodys nerve cells.
Cdc Warns Of Errors In Giving Shingrix Shingles Vaccines
Federal health experts are warning about the risk of problems with Shingrix, GlaxoSmithKlines shingles vaccine, indicating that errors have been reported in recent months due to confusion between the new drug and its older competitor, Zostavax.
The U.S. Centers for Disease Control and Prevention published a report this week in its Morbidity and Mortality Weekly Report , highlighting the number of adverse event reports submitted in recent months involving Shingrix administration errors.
Shingrix is a new GlaxoSmithKline shingles vaccine that was just placed on the market in October 2017. It is only approved for adults age 50 and older, and is one two shingle vaccines that are currently approved in the United States. The other is Mercks Zostavax .
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Vaccine Effectiveness And Safety
The vaccine reduces your chance of getting the virus by more than 50%, depending on your age. Vaccine effectiveness is higher among seniors between 65 and 70 years old.
No vaccine is 100% effective. If you get vaccinated, you may still develop shingles. But the infection would likely be less severe and youd be better protected from complications.
The vaccine has been licenced by Health Canada, having met all requirements under the Food and Drugs Act.
Shingrix Shingles Vaccine News
– Harvard Health reported unvaccinated people who get shingles for the first time should still receive Shungrix to reduce their risk of future attacks, says a study published Sept. 1, 2021, in the Journal of the American Academy of Dermatology.
– GlaxoSmithKline Inc. announced that the SHINGRIX vaccine had been approved in Canada for the prevention of shingles in adults aged 18 years and older who are or who will be at increased risk of shingles due to immunodeficiency or immunosuppression caused by known disease or therapy. Immunocompromised individuals are at greater risk of shingles and associated complications than immunocompetent individuals.
– Local media in Canada reported the Shingrix vaccine will be available to Prince Edward Islanders who are 65 and older for free beginning in January 2022.
– The JAMA Network published an Original Research: Risk of Guillain-Barré Syndrome Following Recombinant Zoster Vaccine in Medicare Beneficiaries. In an observational study of Medicare beneficiaries, a medical record-based, self-controlled analysis of GBS cases after RZV vaccination identified a rate ratio of 2.84 between the risk and control windows, resulting in an attributable risk of 3 cases per million RZV doses. This means these findings suggest that there is an increased risk of developing GBS following vaccination with RZV.
– GSK announced Shingrix revenues reached £502 million, representing a +41% CER.
– GSK reported quarterly sales of Shinrix decreased by about 47%.
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How Long Does It Take To Work
It takes time for your body to make enough antibodies to fight off germs and protect you from certain diseases.
Results from clinical studies of Shingrix showed that the recommended dosing schedule for Shingrix does cause an immune response.
How long Shingrix takes to work may not be the same for everyone. The timing for you will depend on your body chemistry. In general, you should be protected from shingles soon after the second dose.
Studies in animals showed that there was no risk with Shingrix during pregnancy. However, animal studies dont always predict the way humans would respond.
If youre pregnant or planning to become pregnant, wait until after youve had your baby to get the Shingrix vaccine. Talk with your doctor if you have any concerns.
There havent been enough studies to show whether Shingrix appears in breast milk.
Until more is known, its best to wait until youve finished breastfeeding before getting Shingrix.
Shingrix Vs Zostavax: How Do Various Shingles Vaccines Stack Up
Its important to understand what shingles is. Shingles is essentially a reactivation of chickenpox. Chickenpox is a bit of a misnomer. The pox ending refers to its blistering rash. For much of human history it was thought to be similar to smallpox . However, the two infections are entirely unrelated.
Why it was called chicken-pox is not entirely clear since the disease has nothing to do with chickens. A few theories have been put forward. One is that chicken-pox is a linguistic corruption of child-pox since the disease generally affects children. But the real reason is likely lost to history. In any case, we are better off referring to chickenpox by its scientific name of varicella.
Varicella is caused by the aptly named Varicella-zoster virus . Varicella is not a benign illness and it can be fatal, but most people survive the initial infection. However, even though the characteristic rash eventually disappears, the virus is never entirely cleared from the human body. It remains dormant in the dorsal root ganglia, a cluster of nerve cells that run parallel to the spine. Your immune system normally keeps the virus in check. But as we age, immunity can wane. By age 55, 30-40% of people have lost the specific immunity they had to the varicella-zoster virus and the virus can re-awaken.
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Can It Cause Side Effects
Like every vaccine, Shingrix has the potential for side effects, although so far, none seem particularly worrisome. The new shingles vaccine does appear to be more likely to cause pain during injection and at the site of injection for up to three days afterward than Zostavax does.
In clinical trials, the side effects also included injection site redness and swelling, muscle pain, and immune system responses such as headache, shivering, fever, and upset stomach. Most, according to GlaxoSmithKline, its manufacturer, lasted less than three days.
Though Shingrix was tested on some 16,600 adults in clinical trials, its real-world use has been limited. The company will be conducting additional safety and efficacy studies over the next few years, and the CDC will be monitoring any adverse events that are reported.
As with any drug thats approved on the basis of studies in only thousands, in contrast to millions after approval, strict post-marketing surveillance studies have to be agreed upon, with severe penalties for irregularities, says CRs Lipman.
How Long Does It Last
Shingrix provides strong protection against shingles, but studies show that the bodys immunity may decline over time. The duration of Shingrix effectiveness has not been studied in children under 18 years of age. People who receive Shingrix should still get vaccinated against shingles if they are 70 years old or older.
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Shingrix Shingles Vaccine Use For Immunocompromised Adults
During the U.S. CDC’s Advisory Committee on Immunization Practices meeting on October 20, 2021, Tara Anderson, DVM, MPH, Ph.D., presented: Interpretation of the EtR Regarding Use of RZV in Immunocompromised Adults, Considerations for Use, and Proposed Policy Options. The ACIP’s Recommendation is: Two doses of recombinant zoster vaccine are recommended for adults aged 19 years who are or will be immunodeficient or immunosuppressed due to disease or therapy to prevent herpes zoster and its complications. Additionally, Camille Nelson Kotton, M.D., presented an ACIP herpes zoster overview.
Previously, Camille Nelson Kotton, M.D., Chair, ACIP Herpes Zoster Work Group, presented the Introduction Zoster Vaccines Session on September 29, 2021 Ismael R. Ortega-Sanchez, Ph.D. presented ‘Economics of vaccinating immunocompromised 1949-years-old adults against herpes zoster in the USA Tara Anderson, DVM, MPH, Ph.D. presented ‘Preliminary Evidence to Recommendations Framework Regarding Use of Recombinant Zoster Vaccine in Immunocompromised Adults and Next Steps.’