{"id":501,"date":"2023-09-16T22:19:49","date_gmt":"2023-09-16T21:19:49","guid":{"rendered":"https:\/\/microregistrar.com\/?p=501"},"modified":"2023-09-16T22:19:49","modified_gmt":"2023-09-16T21:19:49","slug":"shingles-vaccine-study-note","status":"publish","type":"post","link":"https:\/\/microregistrar.com\/?p=501","title":{"rendered":"Shingles vaccine: study note"},"content":{"rendered":"\n<h5 class=\"wp-block-heading\">Two licensed shingles vaccines are available in the UK: Zostavax\u00ae and Shingrix\u00ae.<\/h5>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><\/td><td><strong>Zostavax\u00ae<\/strong><\/td><td><strong>Shingrix\u00ae<\/strong><\/td><\/tr><tr><td><strong>Live vaccine?<\/strong><\/td><td><strong>Live attenuated vaccine<\/strong><\/td><td><strong>Recombinant vaccine (Not live)<\/strong><\/td><\/tr><tr><td><strong>Strain\/ component<\/strong><\/td><td>Derived from the&nbsp;<strong>OKA\/Merck strain<\/strong>&nbsp;of the Varicella Zoster Virus<\/td><td>Contains varicella-zoster virus&nbsp;<strong>glycoprotein E antigen<\/strong>&nbsp;produced by recombinant DNA technology, adjuvanted with AS01B<\/td><\/tr><tr><td><strong>Route<\/strong><\/td><td>The vaccine is given&nbsp;<strong>IM or Subcutaneous<\/strong>, preferably in the deltoid region of the upper arm.<br><br>For individuals with a bleeding disorder, it should be given by deep subcutaneous injection<\/td><td>IM, preferably in the deltoid region of<br>the upper arm.&nbsp;<strong>Subcutaneous administration is not recommended<\/strong>.<br><br>It should be given IM cautiously in individuals with thrombocytopenia or any coagulation disorder.<\/td><\/tr><tr><td><strong>Dose<\/strong><\/td><td>Adults should receive a&nbsp;<strong>single<\/strong>&nbsp;0.65ml&nbsp;dose.<br>Revaccination is not recommended.<\/td><td><strong>Two doses<\/strong>&nbsp;of 0.5ml of Shingrix\u00ae a minimum of 2 months apart.<\/td><\/tr><tr><td><strong>With another vaccine<\/strong><\/td><td>If given simultaneously as another vaccine, the vaccines should be given at separate sites, preferably in different limbs. If given in the same limb, they should be given at least 2.5cm apart.<\/td><td>If given simultaneously as another vaccine, the vaccines should be given at separate sites, preferably in different limbs. If given in the same limb, they should be given at least 2.5cm apart.<\/td><\/tr><tr><td><strong>Preparation<\/strong><\/td><td>A lyophilised preparation for reconstitution with a diluent<\/td><td>A white powder for reconstitution with diluent and is injected as a suspension.<\/td><\/tr><tr><td><strong>Adverse effects<\/strong><\/td><td><strong>Injection site reactions including:<\/strong><br>\u2013 erythema (redness),<br>\u2013 warmth at the injection site,<br>\u2013 pain,<br>\u2013 swelling,<br>\u2013 pruritis (itching)<br>\u2013 haematoma,<br>Also \u2013&nbsp;<strong>pain in the arm or leg and headache.<\/strong><br><br><strong>Varicella (chickenpox) like illness<\/strong>&nbsp;\u2013 Rare&nbsp;(0.01%)<\/td><td>Pain at the injection site,<br>myalgia, and<br>fatigue.<\/td><\/tr><tr><td><strong>Contraindications<\/strong><\/td><td>\u2013 Confirmed&nbsp;anaphylactic reaction&nbsp;to a previous dose of varicella virus-containing vaccine or any component of the vaccine.<br>\u2013&nbsp;women of childbearing age\/pregnant.<br>\u2013&nbsp;severe immunosuppression<\/td><td>Confirmed&nbsp;anaphylactic reaction&nbsp;to any component of the vaccine.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\">Efficacy:<\/h4>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Zostavax\u00ae<\/strong><\/td><td><strong>Shingrix\u00ae<\/strong><\/td><\/tr><tr><td><strong>Reduction in the incidence of shingles:<\/strong><br>\u226560 years \u2013 about 50 \u2013 65%.<br>\u226570 years \u2013 about 38%<br><br><strong>Reduction in the incidence of postherpetic neuralgia (PNH):<\/strong>&nbsp;66- 81%.<br><br><strong>The duration of protection<\/strong>&nbsp;following a single dose is unknown. Likely to be 3 years or longer.<br><br>In the UK, vaccination programme effectiveness reduced from 69% to 45% over 3 years.<\/td><td><strong>One and two-dose effectiveness:<\/strong><br>In over 65 years \u2013 one dose 56.9% and two doses \u2013 70.1% effective<br>Two-dose effectiveness against postherpetic neuralgia \u2013 76%.<br><br>RCT and clinical trials found&nbsp;<strong>vaccine efficacy<\/strong>&nbsp;\u2013<br>\u2265 50 years \u2013 97.2%<br>\u226570 years \u2013 91.2%<br>Immunocompromised patients (including NHL and CLL) \u2013 87.2%<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\">National programme<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Routine vaccination for people aged 70 years, using Zostavax\u00ae<\/li>\n\n\n\n<li>A catch-up programme was rolled out to those aged 70-79 years in a phased approach.<\/li>\n<\/ul>\n\n\n\n<p><strong>It is not recommended<\/strong><br><em>\u2013 for use from age 50 routinely. (Although it is effective and licensed in this age group, routine use is not recommended, as the burden of shingles disease is generally not as severe)<br><\/em>\u2013&nbsp;<em>It is not cost-effective to use over 80 years old (due to the vaccine\u2019s lower effectiveness in older individuals).<br>\u2013 not indicated for the prevention of primary VZV infection (chickenpox) and should not be used in children and adolescents.<\/em><br><em>\u2013 Zostavax\u00ae or Shingrix\u00ae are not recommended for post-exposure prophylaxis or as a treatment for chickenpox, shingles, or postherpetic neuralgia (PHN).<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Immunocompromised patients who are eligible for shingles vaccine (70-79 years) but unable to take live vaccine \u2013 should receive Shingrix\u00ae. However, people with lower levels of immunosuppression should be offered Zostavax\u00ae instead due to the limited supply of Shingrix\u00ae.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Specific situations<\/h4>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Individuals who have shingles<\/strong><\/td><td>Individuals who have shingles should wait until symptoms have ceased before being considered for shingles immunisation.<\/td><\/tr><tr><td><strong>Recurrent shingles<\/strong><\/td><td><strong>Concurrent use of aciclovir, high-dose IVIG or varicella immunoglobulin<\/strong><\/td><\/tr><tr><td>1. It is a rare complication of Zostavax\u00ae.<br>2. There is a possibility that it could be transmitted to a susceptible person. As a precautionary measure, the rash area should be covered when in contact with a susceptible (chickenpox na\u00efve) person until the rash is dry and crusted.<br>3. Prophylactic aciclovir can be considered in vulnerable patients exposed to varicella-like rash in a recent vaccine.<br>4. If the person who received the vaccine is immunosuppressed, they should avoid contact with susceptible people until the rash is dry and crusted due to the higher risk of virus shedding.<br>5. Contact tracing is not required if an immunocompetent person develops a localised vesicular rash following Zostavax\u00ae vaccination.<br>6. A vesicle fluid sample should also be sent for analysis to confirm the diagnosis and determine whether the rash is vaccine-associated or wild-type. This service is available at the Virus Reference Department (VRD) at Public Health England, Colindale.<\/td><td>Zostavax\u00ae should be delayed in individuals who are being<br>\u2013 treated for non-varicella zoster infections with either oral or intravenous antivirals (such as aciclovir)\/receiving aciclovir prophylaxis until 48 hours after cessation of treatment or<br>\u2013 high dose IVIG\/ varicella-zoster immunoglobulin (VZIG) in the previous 6 weeks.<\/td><\/tr><tr><td><strong>People developing a varicella-like rash after vaccination<\/strong><\/td><td>1. It is a rare complication of Zostavax\u00ae.<br>2. There is a possibility that it could be transmitted to a susceptible person. As a precautionary measure, the rash area should be covered when in contact with a susceptible (chickenpox na\u00efve) person until the rash is dry and crusted.<br>3. Prophylactic aciclovir can be considered in vulnerable patients exposed to varicella like rash in a recent vaccine.<br>4. If the person who received the vaccine is immunosuppressed, they should avoid contact with susceptible people until the rash is dry and crusted due to the higher risk of virus shedding.<br>5. Contact tracing is not required if an immunocompetent person develops a localised vesicular rash following Zostavax\u00ae vaccination.<br>6. A vesicle fluid sample should also be sent for analysis to confirm the diagnosis and determine whether the rash is vaccine-associated or wild type. This service is available at the Virus Reference Department (VRD) at Public Health England, Colindale.<\/td><\/tr><tr><td><strong>Inadvertent vaccination of Zostavax\u00ae in immunosuppressed individuals<\/strong><\/td><td>assess the degree of immunosuppression.<br>Most people in this age group are varicella IgG+ve, so varicella-zoster immunoglobulin (VZIG) is unlikely to benefit, but prophylactic aciclovir may be considered.<br>Those who develop rash should be assessed and considered for IV high-dose aciclovir.<\/td><\/tr><tr><td><strong>Inadvertent vaccination of Zostavax\u00ae in pregnancy<\/strong><\/td><td>Treat the inadvertent administration of the Zostavax\u00ae vaccine in a pregnant woman the same way as natural exposure to chickenpox infection.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\">Co-administration with another vaccine<\/h4>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><\/td><td><strong>Zostavax\u00ae<\/strong><\/td><td><strong>Shingrix\u00ae<\/strong><\/td><\/tr><tr><td>Inactivated influenza<\/td><td>can be given at the same time as inactivated influenza vaccination.<\/td><td>Should ideally be separated by an interval of at least 7 days to avoid incorrect attribution of potential adverse events.<br>However, coadministration can be considered if rapid protection requires or individuals are likely to be lost to follow up.<\/td><\/tr><tr><td>23-valent pneumococcal polysaccharide<br>vaccine<\/td><td>Zostavax\u00ae can be given at the same time<\/td><td><\/td><\/tr><tr><td>COVID-19 vaccination<\/td><td>should ideally be delayed for seven days after<br>COVID-19 vaccination and vice versa<\/td><td>should ideally be delayed for seven days after<br>COVID-19 vaccination and vice versa<\/td><\/tr><tr><td>MMR, yellow fever<\/td><td>four-week interval is observed<br>between administration of MMR and Zostavax\u00ae vaccines<\/td><td><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\">Severe immunosuppression<\/h4>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td>Categories<\/td><td><strong>Example<\/strong><\/td><\/tr><tr><td>Individuals with primary or acquired immunodeficiency states due to conditions<br>including:<\/td><td>Individuals with chronic immune-mediated inflammatory disease who are receiving or have received immunosuppressive therapy<\/td><\/tr><tr><td>Individuals on immunosuppressive or immunomodulating therapy including:<\/td><td>\u25cf those who are receiving or have received in the past 6 months immunosuppressive chemotherapy or radiotherapy for any indication<br>\u25cf those who are receiving or have received in the previous 6 months immunosuppressive therapy for a solid organ transplant<br>\u25cf those who are receiving or have received in the previous 3 months targeted therapy for autoimmune diseases, such as JAK inhibitors or biologic immune modulators, including B-cell targeted therapies (including rituximab but for which a 6 month period should be<br>considered immunosuppressive), monoclonal tumour necrosis factor inhibitors (TNFi), T-cell co-stimulation modulators, soluble TNF receptors, interleukin (IL)-6 receptor inhibitors., IL-17 inhibitors, IL 12\/23 inhibitors, IL 23 inhibitors (N.B: this list is not exhaustive)<\/td><\/tr><tr><td>\u25cf moderate to high dose corticosteroids (equivalent \u226520mg prednisolone per day) for more than 10 days in the previous month<br>\u25cf long term moderate dose corticosteroids (equivalent to \u226510mg prednisolone per day for more than 4 weeks) in the previous 3 months<br>\u25cf any non-biological oral immune-modulating drugs e.g. methotrexate &gt;20mg per week (oral and subcutaneous), azathioprine &gt;3.0mg\/kg\/day; 6-mercaptopurine &gt;1.5mg\/kg\/day,<br>mycophenolate &gt;1g\/day) in the previous 3 months<br>\u25cf certain combination therapies at individual doses lower than stated above, including those on \u22657.5mg prednisolone per day in combination with other immunosuppressants (other than hydroxychloroquine or sulfasalazine) and those receiving methotrexate (any dose) with leflunomide in the previous 3 months<\/td><td>\u25cf moderate to high dose corticosteroids (equivalent \u226520mg prednisolone per day) for more than 10 days in the previous month<br>\u25cf long term moderate dose corticosteroids (equivalent to \u226510mg prednisolone per day for more than 4 weeks) in the previous 3 months<br>\u25cf any non-biological oral immune-modulating drugs, e.g. methotrexate &gt;20mg per week (oral and subcutaneous), azathioprine &gt;3.0mg\/kg\/day; 6-mercaptopurine &gt;1.5mg\/kg\/day,<br>mycophenolate &gt;1g\/day) in the previous 3 months<br>\u25cf certain combination therapies at individual doses lower than stated above, including those on \u22657.5mg prednisolone per day in combination with other immunosuppressants (other than hydroxychloroquine or sulfasalazine) and those receiving methotrexate (any dose) with leflunomide in the previous 3 months<\/td><\/tr><tr><td>Individuals who have received a short course of high-dose steroids (equivalent to &gt;40mg prednisolone per day for more than a week) for any reason in the previous month.<\/td><td><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Two licensed shingles vaccines are available in the UK: Zostavax\u00ae and Shingrix\u00ae. Zostavax\u00ae Shingrix\u00ae Live vaccine? Live attenuated vaccine Recombinant [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ngg_post_thumbnail":0,"footnotes":""},"categories":[11],"tags":[173,172,17],"class_list":["post-501","post","type-post","status-publish","format-standard","hentry","category-vaccine","tag-chickenpox","tag-shingles","tag-vaccine"],"_links":{"self":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/501","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=501"}],"version-history":[{"count":2,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/501\/revisions"}],"predecessor-version":[{"id":650,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/501\/revisions\/650"}],"wp:attachment":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=501"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=501"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=501"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}