Herpes zoster, more commonly known as shingles, affects close to one million people per year in the US1. It is caused by the reactivation of a virus called varicella zoster which results in a painful skin rash, which may lead to postherpetic neuralgia that may persist for up to 90 days after initial resolution of the blistering rash2. Moreover, as the US population ages, a person’s risk of developing shingles increases. With so much at stake, preventative medicine is an area of patient care where pharmacists can have a direct impact in helping stem the tide of cases. It’s at this point, immunizations are the most cost-effective way to prevent shingles and many other diseases.
Currently, there are two vaccines approved to prevent shingles: the shingle zoster vaccine live (Zostavax) and shingles recombinant zoster vaccine (Shingrix). Between the two, the Advisory Committee on Immunization Practice prefers Shingrix. The FDA approved Shingrix on October of 2017 as an intramuscular 2-dose vaccine series that is recommended for immunocompetent adults ≥ 50 years3. The effectiveness of Shingrix was evaluated in a two-part, phase III, multicenter trial that evaluated Shingrix efficacy with more than 30,000 participants. The ZOE-50 trial group results concluded that the vaccine efficacy after the 1st year was greater than 97% compared to placebo4. The ZOE-70 trial results concluded that vaccine efficacy was about 90% in patients older than 705. In a pooled analysis of both studies in patients over 70, results showed that vaccine efficacy against herpes zoster was 91.3% and 88.8% against postherpetic neuralgia.
Based on findings from the shingles studies, the Centers for Disease Control and Prevention (CDC) published core recommendations for patients ≥ 50 years to receive the Shingrix vaccine5, with the second dose of the vaccine being administered 2 to 6 months after the initial dose. While Shingrix is not recommended in patients that have an active acute episode of herpes zoster, it is recommended for patients with a resolved previous infection of herpes zoster. For patients that have had a previous Zostavax vaccine, it is best to wait at least 8 weeks before administering Shingrix. The only known contraindication for the vaccine is for patients that have a severe allergic reaction to the contents of the Shingrix. Finally, it is recommended that any adult with an acute illness wait to receive their vaccine until their illness is resolved.
The two-dose Shingrix vaccine series has an estimated cost of $280, based on most drug store chain pharmacies. While most insurance companies cover the cost of the vaccine for patients, some still require a co-pay. The vaccine must be reconstituted to a 0.5 mL dose prior to injection. Pharmacists play a crucial role in reminding the patient to complete the full series by calling patients to remind them of their second dose within 2-6 months of their initial Shingrix injection.
PharmD Live telehealth solutions, including Chronic Care Management (CCM) and Medicare Annual Wellness Visits, emphasize the importance of vaccinations, thereby reducing the disease burden on our patient population. We provide patients and their healthcare providers with 24/7 access to a clinical pharmacist, who can assist the patient if he or she experiences a common adverse reaction such as injection site redness, swelling, fever, or upset stomach. The patient’s benefit for receiving the shingles vaccine generally outweighs the risk, and this is assessed during an initial visit with a PharmD Live clinical pharmacist.
PharmD Live Blog for Providers offers insight on topics of interest to the healthcare community. Researched by our team of clinical pharmacists, this blog references information that is current as of the date of posting. For further information, please visit the references below, or contact our pharmacy team on the Contact page. Thank you for reading!References1. Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc 2007;82:1341–9. DOI: 10.4065/82.11.13412. Food and Drug Administration. Shingrix [package insert]. Silver Spring, MD: US Department of Health and Human Services, Food and Drug Administration; 2017.3. Lal H, Cunningham AL, Godeaux O, et al. ; ZOE-50 Study Group. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med 2015;372:2087–96. DOI: 10.1056/NEJMoa15011844. Cunningham AL, Lal H, Kovac M, et al. ; ZOE-70 Study Group. Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older. N Engl J Med 2016;375:1019–32.DOI: 10.1056/NEJMoa16038005. Centers for Disease Control and Prevention. Shingrix Recommendations. Accessed October 26, 2020.