You'll get more questions about Shingrix, the new zoster vaccine...especially now that CDC prefers it over Zostavax.
Give Shingrix starting at age 50...instead of 60. It seems to prevent shingles better than Zostavax...and immunity may last longer.
But Shingrix requires two intramuscular doses, 2 to 6 months apart...versus one subcutaneous dose with Zostavax.
Does a patient who's had Zostavax need 2 Shingrix doses? Yes...to boost immunity. Wait at least 2 months after Zostavax to give Shingrix.
Give Shingrix even if the patient has had shingles...but wait until acute symptoms, such as the rash, go away.
Can immunocompromised patients get Shingrix? In some cases, yes...it's a NON-live recombinant vaccine with an adjuvant.
For example, feel comfortable giving Shingrix to patients on less than 20 mg/day of prednisone. This is low-level immunosuppression.
It may be safe and effective in high-level immunosuppression, such as posttransplant...but wait for CDC guidance, possibly later this year.
Are injection site reactions common with Shingrix? Yes...as well as possible aches, fatigue, shivering, etc. Inform patients these may last a couple of days...but don't seem to worsen with the second Shingrix dose.
Can Shingrix be given at the same time as other vaccines? Generally yes...including flu, pneumococcal, and Tdap. There isn't much evidence about co-administration, but CDC guidelines don't suggest a concern.
Will Zostavax be discontinued? Probably not soon...so work with your staff to prevent mix-ups between Shingrix and Zostavax.
If Shingrix is given subcutaneously instead of IM, don't repeat the dose. But follow your pharmacy's policy for reporting vaccine errors.
Store both Shingrix vials in the FRIDGE. Discard if accidentally frozen...below 32°F for the adjuvant or -13°F for the vaccine. And reconstitute Shingrix with its adjuvant...NOT the Zostavax diluent.
Expect many Medicare D plans and other payers to cover Shingrix. Ensure patients get the second dose...use reminders, profile notes, etc.
See our chart, Shingles Vaccine: FAQs, for more answers.
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