Missed or early doses of Shingrix If more than six months have passed since the initial dose of Shin- grix, the vaccine series does not need to be restarted. However, the ACIP notes that the safety and efficacy of alternate dosing regimens has not been studied, and patients may remain at risk of
developing herpes zoster if longer-than-recommended intervals between the first and second doses are utilized. If the second dose of Shingrix is administered less than four weeks after the first dose, the ACIP recommends repeating the second dose (Dooling et al., 2018). patients. As additional data becomes available, the committee is expected to further discuss this topic (Dooling et al., 2018). Patients with chronic medical conditions Shingrix is recommended in patients with chronic medical con- ditions such as diabetes, chronic obstructive pulmonary disease, chronic renal failure, and rheumatoid arthritis (Dooling et al., 2018). Patients without a history of chicken pox There is no recommendation to screen for a history of chicken pox before administration of Shingrix. However, in patients who have no prior history of chicken pox or vaccination against chicken pox, the ACIP recommends following guidelines for the administration of the varicella vaccination. (Dooling et al., 2018).
Special populations History of herpes zoster
Because of the potentially recurrent nature of herpes zoster, adults who have previously developed shingles should receive Shingrix. If the patient is currently experiencing a shingles episode, immu- nization should be delayed until the acute phase has passed and symptoms have resolved (Dooling et al., 2018). Patients who are immunocompromised The ACIP recommends using Shingrix in patients taking low-dose immunosuppressive medications, such as less than 20 mg per day of prednisone, as well as patients expecting to begin immuno- suppressive therapy and those who have recently recovered from an immunosuppressive illness. Since patients taking moderate- to high-dose immunosuppressive therapy and those who are cur- rently immune-compromised were excluded from efficacy stud - ies, the ACIP has not recommended the use of Shingrix in these Conclusion Since shingles has the potential to affect over 30% of Americans, it is important to be aware of the disease process, treatment, and prevention of this common disease state. The Shingrix vaccine has demonstrated significant efficacy in preventing shingles out - breaks, and its high efficacy rates have prompted the Advisory References • Albrecht, M. A. (2019). Patient education: Shingles (beyond the basics). UpToDate . Retrieved October 19, 2021, from http://www.uptodate.com/contents/shingles-beyond-the- basics • Albrecht, M. A., & Levin, M. J. (2021). Epidemiology, clinical manifestations, and diagnosis of herpes zoster. UpToDate . Retrieved October 19, 2021 from https://www. uptodate.com/contents/epidemiology- clinical-manifestations-and-diagnosis-of- herpes- zostersearch=shingles&source=search_result&selectedTitle=2~150&usage_ type=default&display_rank=2 • Centers for Disease Control and Prevention. (2019). About shingles. http://www.cdc.gov/ shingles/about/index.html • Centers for Disease Control and Prevention. (2020). Adjuvants and vaccines. http://www. cdc.gov/vaccinesafety/concerns/adjuvants.html • Centers for Disease Control and Prevention, Lopez, A., Harrington, T., & Marin, M. (2021). Chapter 22: Varicella. In E. Hall, A. P. Wodi, J. Hamborsky, V. Morelli, & S. Schillie (Eds.), Epidemiology and Prevention of Vaccine-Preventable Diseases . www.cdc.gov/vaccines/ pubs/pinkbook/downloads/varicella.pdf • Dooling, K. L., Guo, A., Patel, M., Lee, G. M., Moore, K., Belongia, E. A., & Harpaz, R. (2018, January 26). Recommendations of the advisory committee on immunization practices for
Committee on Immunization Practices (ACIP) to recommend it for the prevention of herpes zoster. Being aware of these recommen- dations allows pharmacy professionals to better serve and protect patients against this potentially harmful disease.
use of herpes zoster vaccines. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, 67 (3), 103–108. http://dx.doi.org/10.15585/mmwr.mm6703a5 • GlaxoSmithKline. (2021). Shingrix package insert. www.fda.gov/downloads/ BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM581605.pdf • Kowalsky, D. S., & Wolfson, A. B. (2019). Corticosteroids for preventing postherpetic neuralgia after herpes zoster infection. NNT [Number-Needed-to-Treat]. https://www.thennt. com/nnt/corticosteroids- preventing-postherpetic-neuralgia-herpes-zoster-infection/ • Papadopoulos, A. J. (2020). Chicken pox treatment and management. Medscape. http:// emedicine.medscape.com/article/1131785-treatment#showall • Shiraki, K., Takemoto, M., & Daikoku, T. (2021). Emergence of varicella-zoster virus resistance to acyclovir: epidemiology, prevention, and treatment. Expert Review of Anti- infective Therapy , 1–11. Advance online publication. https://doi.org/10.1080/14787210.20 21.1917992
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