From 1 November, Shingrix will replace Zostavax on the National Immunisation Program (NIP), with free coverage expanded to people aged ≥65 and First Nations people aged ≥50, as well as immunocompromised people with certain medical conditions who are aged ≥18.
Consultant geriatrician and Associate Professor Michael Woodward, from Austin Hospital in Melbourne, says it’s important not to underestimate the impact shingles can have on peoples’ when considering offering the vaccine.
Post-herpetic neuralgia is the most common complication and can cause very severe pain and loss of independence. Herpes zoster ophthalmicus affects 10-20% of herpes zoster virus cases, and can also lead to serious complications including vision loss. Shingles can also impact enjoyment of life, mood and sleep—and other complications can include disseminated disease, scarring, hearing loss, neurological problems, and cardiovascular and cerebrovascular events.
How does the vaccine work?
Shingrix consists of a spike antigen combined with an adjuvant system.
“The adjuvant gets around the immunosenescence, which is not only the cause of shingles occurring, but also the cause of some vaccines not being as effective in older people,” Associate Professor Woodward says.
Is Shingrix safe for immunocompromised people?
Yes. Shingrix does not contain any live virus, so it is safe to give immunocompromised people aged ≥18, and will be funded for those with haemopoietic stem cell transplant, solid organ transplant, haematological malignancy, and advanced or untreated HIV.
How effective is Shingrix?
When it comes to efficacy, Shingrix outperforms its predecessor Zostavax. Efficacy for Shingrix has been found to be 90% and protections seems to last 9-10 years (Zostavax efficacy was reported at about 60% with protection waning after a few years).
What is the side effect profile?
Common side effects include localised pain, redness and swelling, as well as systemic effects such as fever, headache, fatigue, myalgia, gastrointestinal symptoms and shivering.
According to the Australian Immunisation Handbook (AIH), 82% of clinical trial participants aged ≥ 50 and 74% of those aged ≥ 70 had injection site reactions to Shingrix, while 66% of the 50-and-overs and 73% of 70-and-overs had systemic adverse events.
While these are common, they generally don’t impede normal activities.
About 10% of people have reactions that disrupt daily activities; these generally resolve within 1-3 days without treatment.
Clinical trial data showed no difference in rates of serious adverse events between Shingrix and placebo, according to the AIH.
Should you wait until patients turn 65 to offer Shingrix?
Associate Professor Woodward says no.
“I would advise offering it to all patients at age 50 (earlier if immunocompromised) as that is when the risk increases – but they have to pay if they’re not 65 or older,” Associate Professor Woodward explains.
For those not eligible under the NIP, Shingrix usually costs up to $560.
What if my patient had Zostavax?
“Here again the answer is clear,” Associate Professor Woodward says. “After one year, offer Shingrix if over age 50- it is much more effective and immunity from Zostavax wanes after a few years.”
However, people who have already received a free Zostavax shingles vaccine can’t get a free Shingrix vaccine for at least 5 years after they have had Zostavax. But if they had Zostavax privately they can receive Shingrix® free under the NIP if they are eligible.
An interval of at least 12 months is recommended between Zostavax and the first Shingrix dose.
If a patient is over 65 and has had shingles within the past year, do they require immunisation at all or will they have lasting immunity?
“They have a 6% chance of a second episode and should be vaccinated 12 months after the episode- hopefully leading to lifelong immunity,” says Associate Professor Woodward.
A 2-dose course of Shingrix will be available for free for: |
Beyond this, it is indicated for prevention of herpes zoster and post-herpetic neuralgia in adults ≥50 and those ≥18 who are at increased risk of herpes zoster. It is contraindicated in those with hypersensitivity to any ingredient in the vaccine (Refer to the full Product Information before prescribing). After 31 October, Zostavax will no longer be funded on the NIP. |
For more information
Zoster (herpes zoster) | The Australian Immunisation Handbook (health.gov.au)
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