COMMENTARY

Everything You Need to Know About Shingrix, and How Shingrix Differs From Zostavax

Kathleen Dooling, MD, MPH

Disclosures

April 30, 2018

Editorial Collaboration

Medscape &

Hello. I'm Dr Kathleen Dooling, a medical officer and shingles disease expert at CDC. I'm here to talk to you about the new, highly protective shingles vaccine, Shingrix. It is more than 90% protective against shingles, even among the elderly.[1,2] CDC now recommends Shingrix as the preferred shingles vaccine for immunocompetent adults age 50 and older.[3] Today I'm going to focus on two important aspects of Shingrix recommendations: first, proper vaccine administration; and second, how to counsel patients about possible reactions.

CDC recommends two doses of Shingrix, with the second dose given 2-6 months after the first.[3,4] The effectiveness of only one dose has not been studied, so to get full protection, patients should complete the two-dose series. Even if a patient previously received Zostavax, CDC recommends that they receive two doses of Shingrix. You should administer Shingrix intramuscularly in the deltoid region of the upper arm.[4] This is very important, because if Shingrix is incorrectly administered subcutaneously, the patient is more likely to develop a reaction.[1,2]

Shingrix is supplied as two components: the lyophilized antigen and the adjuvant solution. Both components should be stored in the refrigerator between 2˚ and 8˚ C, and the vaccine should be reconstituted prior to use.[4] You should not freeze Shingrix; once frozen, the vaccine is no longer viable. The vaccine storage and administration of Shingrix is quite different from that for Zostavax, a live attenuated shingles vaccine that CDC has recommended since 2006.

The second point I'd like to discuss today is reactions, or possible reactogenicity, associated with Shingrix. In clinical trials of more than 30,000 people, Shingrix was not associated with serious adverse events.[1,2] However, local and systemic reactions were common among those who got the vaccine. More than 75% of people who got Shingrix reported at least some pain at the injection site.[1,2] About 17% of patients who got Shingrix reported grade 3 reactions, which are severe enough to prevent normal activities. One in 10 reported grade 3 reactions due to pain or injection-site redness or swelling of at least 4 inches in diameter.[1,2] Also, about 1 in 10 people who got Shingrix reported systemic effects that limited activity, such as myalgia, fatigue, headache, shivering, fever, or gastrointestinal illness.[1,2]

CDC recommends counselling your patients about the possible reactions to the vaccine before administering Shingrix. Advise patients not to engage in strenuous activities for a few days after vaccination. If reactions do occur, you can suggest that patients take over-the-counter ibuprofen or acetaminophen to help relieve pain and inflammation. In clinical trials, a reaction to the first dose did not predict a reaction to the second dose.[1,2] Therefore, you should encourage patients to complete the two-dose series, even if they experience a reaction to the first dose. Most reactions to Shingrix are self-limited and resolve in 2-3 days. Report any clinically significant reactions online to the Vaccine Adverse Event Reporting System.

For more information, you can access the herpes zoster vaccine recommendations published in the Morbidity and Mortality Weekly Report[3] or visit CDC's shingles vaccine website.

As a healthcare provider, your recommendations on vaccination have the biggest impact on the choices your patients make. So help protect your patients ages 50 and older against shingles and its complications by strongly recommending shingles vaccination. Thank you.

Web Resources

Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines

Shingles Vaccine Information for Healthcare Professionals

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