Shingrix vaccine

‍Shingrix vaccine is effective

• Over 90% efficacy against both zoster and post herpetic neuralgia in participants aged over 50 years.
• Over 84% for at least 7 years, in those over 70 years, including those with comorbidities.

‍It is a 2 dose course with no booster

• Second dose is given 2–6 months after the first dose. If a longer interval occurs between the two doses, there is no need to restart the course.
• Two doses provide good protection for at least 8 years, with no evidence of waning.
• No booster required.

 Common responses to the vaccine

• Generally well tolerated.
• Commonly pain at the injection site, myalgia and fatigue, headache, shivering, fever and gastrointestinal symptoms.
• Mild to moderate and last 1–3 days.

 Shingrix can be given at different sites with all NIS vaccines

• Any vaccine can be administered at the same time as Shingrix, provided they are given at separate sites.
• FLUAD QUAD, Shingrix and Nuvaxovid utilise adjuvants to gain a good immune response. Consumers should be informed of the possibility of a stronger post-vaccination response, where two or more of these vaccines are administered at the same visit.
• Caution is advised between the co-administration of Shingrix and Arexvy, as they contain the same adjuvant. Trials are underway to assess this, but until further data is available it is recommended that there is a minimum of a 7-day spacing between these two vaccines. During the winter months, Arexvy should be prioritised unless the person is nearly 66 years and risks missing out on funding for Shingrix (which is available for those aged 65 years only).

Funding and eligibility

 Funded for people aged 65 years

• At 65 years of age only (ie first dose anytime in the 12 months following the 65th birthday).
  • Second dose can be given at 66 years of age.

Funded for people aged 18 years of age or older at higher risk of zoster complications with any of the following:

• pre- and post- haematopoietic stem cell transplant or cellular therapy
• pre- or post- solid organ transplant
• haematological malignancies
• people living with poorly controlled HIV infection
• planned or receiving disease modifying anti-rheumatic drugs (DMARDs - targeted synthetic, biologic, or conventional synthetic) for:
  • polymyalgia rheumatica
  • systemic lupus erythematosus
  • rheumatoid arthritis
• end stage kidney disease (CKD 4 or 5)
• primary immunodeficiency

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Approved for use from 50 years, or 18 years at increased risk, but not funded

• 50 years or older to prevent zoster and post herpetic neuralgia
• 18 years for those at increased risk of zoster and post herpetic neuralgia, eg due to other types of immunocompromise not listed above.

‍Order non-funded vaccine from HCL

• Non-funded Shingrix must be ordered from HCL.

Shingrix and the patient/customer

 Patient history issues

• previous varicella disease or vaccination doesn't matter, still vaccinate with Shingrix.
• previous vaccination with Zostavax: can receive Shingrix, a two dose course of Shingrix is still required.
• those who have recently had shingles can wait 12 months before having Shingrix as immunity will provide protection.
• previous hypersensitivity to Shingrix or any component of the vaccine: do not use Shingrix without first seeking clinical advice.
• previous ocular complications from zoster - wait 12 months after resolution.

Immunocompromised patients can have Shingrix

• Shingrix is not a live vaccine so can be given to immunocompromised people.

Zoster antivirals - patients can have Shingrix

• Shingrix is not a live vaccine so can be given to patients on antiviral medication.

Acutely unwell - do not give Shingrix to acutely unwell or febrile patients

As with all vaccines, it should not be given to a patient who is acutely unwell or febrile with a temperature >38˚C.

Pregnancy - get advice if patient is pregnant

• Due to a lack of data for Shingrix in pregnancy, please contact IMAC if Shingrix is indicated for a pregnant individual.