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Frequently Asked Questions About Shingrix

Shingrix is the preferred shingles vaccine. You and patients should make every effort to ensure that two doses are administered within the recommended 2-6 month interval. If more than 6 months have elapsed since the first dose, administer the second dose as soon as possible. Do not restart the vaccine series, and do not substitute Zostavax® (zoster vaccine live) for the second dose of Shingrix. If you are out of Shingrix and a patient needs a second dose, the Vaccine Finder may be helpful for patients to locate other providers who have Shingrix.

Q: Is Shingrix currently on backorder?

A: Yes. Due to high levels of demand for GSK’s Shingrix vaccine, providers should anticipate ordering limits and intermittent shipping delays for Shingrix. It is anticipated order limits and shipping delays will continue throughout 2019. GSK increased the US supply available for 2018 and plans to make even more doses available in the US in 2019. Additionally, GSK will continue to release doses to all customer types on a consistent and predictable schedule during 2019.

Q: What is the clinical guidance during the Shingrix delay?

A: Shingrix is the preferred shingles vaccine. You and patients should make every effort to ensure that two doses are administered within the recommended interval. If more than 6 months have elapsed since the first dose, administer the second dose as soon as possible. Do not restart the vaccine series, and do not substitute Zostavax® (zoster vaccine live) for the second dose of Shingrix. If you are out of Shingrix and a patient needs a second dose, the Vaccine Finder may be helpful for patients to locate other providers that have Shingrix.

Until demand can be met, it is particularly important that vaccine providers educate patients about the importance of completing the series. In addition, CDC reminds health care professionals of proven strategies to help patients receive all their needed vaccinations on time, including Shingrix:

  • Implement a vaccine reminder and recall system using phone, e-mail, or text messages to contact patients when you have Shingrix supply. Give first consideration to patients due for their second dose of Shingrix. (https://www.thecommunityguide.org/findings/vaccination-programs-client-reminder-and-recall-systems)
  • If you are out of Shingrix and a patient needs a second dose, refer the patient to another provider in the community (e.g., a pharmacy) that has Shingrix so the patient can complete the series. The immunization program at your state or local health department or vaccine finder can help identify other immunization providers.
  • Be sure to enter your patients’ current vaccination information into your state’s immunization information system (IIS). This will ensure that every provider can access your patients’ immunization record, and it may help facilitate patient reminders to complete the Shingrix series.
  • As supply becomes less constrained, be sure to notify eligible patients so they can come in to get their first dose of Shingrix.

CDC still recommends Zostavax® for healthy adults 60 years and older to prevent shingles. This shingles vaccine may be used in certain cases, such as when a person prefers Zostavax or requests immediate vaccination and Shingrix is unavailable. Patients who have received Zostavax are recommended to subsequently receive Shingrix. Age and time since receipt of Zostavax may be considered to determine when to vaccinate with Shingrix (minimum interval of 8 weeks).

Q: How should I administer Shingrix?

A: You should administer Shingrix (recombinant zoster vaccine) intramuscularly in the deltoid [1 page] region of the upper arm.

Q: Do I need to reconstitute Shingrix?

A: Yes, prepare Shingrix by reconstituting the antigen component with the adjuvant suspension component. Either administer it immediately, or store it in the refrigerator and use it within 6 hours of reconstitution. Otherwise, discard it. See the Shingrix package insert for detailed instructions.

Q: Where should I store Shingrix?

A: Shingrix must be stored in the refrigerator between 2-8oC. Do not freeze. Discard if the vaccine has been frozen.

Q: How many doses of Shingrix do I give?

A: Give Shingrix in a two-dose series, regardless of a whether a patient has had shingles or received Zostavax (zoster vaccine live) in the past. You should give the second dose of Shingrix 2 to 6 months after you gave the first dose.

Q: How long should I wait after giving the first dose of Shingrix to give the second dose?

A: You should give the second dose of Shingrix 2 to 6 months after you gave the first dose.

Q: What should I do if a patient waits longer than 6 months to get the second dose?

A: You should give the second dose as soon as possible. However, you do not need to restart the vaccine series.

CDC Expert Commentary with Medscape

Medscape video; Dr. Kathleen Dooling

Everything You Need to Know About Shingrix
[3:58 mins]
Dr. Kathleen Dooling discusses storage, administration, and patient counseling for the new shingles vaccine
Released: 4/30/18

Q: How long after a person received Zostavax—the shingles vaccine in use since 2006—should I wait to give Shingrix?

A: Studies confirmed that Shingrix was safe and immunogenic when administered 5 or more years after Zostavax. Intervals shorter than 5 years have not been studied. However, there are no data or theoretical concerns to indicate Shingrix would be less safe or effective when given less than 5 years after Zostavax. You may consider an interval shorter than 5 years, especially if your patient was >70 years old when they received Zostavax. Wait a minimum of 8 weeks after a person received Zostavax to give Shingrix.

Q: How long after a person received chickenpox vaccine should I wait to give Shingrix?

A: Wait a minimum of 8 weeks after a person received Varivax to give Shingrix.

Q: Can I give Shingrix with other adult vaccines?

A: Yes, Shingrix is an inactive vaccine so you can administer it with other inactive or live vaccines. If you administer Shingrix and another vaccine to someone on the same day, give them at different anatomical sites (e.g., different arms). For more information see the Best Practices of the Advisory Committee on Immunization Practices (ACIP).

Q: Can Shingrix be administered to immunocompromised individuals?

A: While Shingrix is not contraindicated in immunocompromised persons, it is not recommended by ACIP at this time. ACIP will begin reviewing evidence for Shingrix in immunocompromised people as soon as it becomes available and will modify vaccine policy as necessary. You can still give Shingrix to someone who is taking low-dose immunosuppressive medication, anticipating immunosuppression, or has recovered from an immunocompromising illness.

Q: What are the primary differences between Shingrix and Zostavax?

A: 

Differences between Shingrix and Zostavax
Characteristic Shingrix (recombinant zoster vaccine [RZV], GlaxoSmithKline [GSK]) Zostavax (zoster vaccine live [ZVL], Merck)
Vaccine Type Inactivated recombinant, adjuvanted (non-live) Live attenuated
Vaccine Composition Supplied as 2 components:
  1. lyophilized glycoprotein E antigen
  2. AS01B adjuvant suspension
Supplied as 2 components:
  1. lyophilized vaccine
  2. sterile water diluent
Storage
  • Refrigerate both the vaccine and diluent at +36° to +46°F (2° to 8°C)
  • DO NOT FREEZE. Do not use if frozen
  • Freeze the vaccine at -58°F to +5°F (-50°C to -15°C)
  • Store diluent separately at room temperature (no warmer than +77° (25° C), or in the refrigerator at +36°F to 46°F (2° C to 8°C)
Preparation
  • Reconstitute the vaccine with the diluent supplied by the manufacturer
  • Administer immediately after reconstitution or refrigerate and use within 6 hours
  • Discard reconstituted vaccine if not used within 6 hours
  • Upon removal of vaccine from the freezer, reconstitute the vaccine with the diluent supplied by the manufacturer
  • Administer immediately after reconstitution
  • Discard reconstituted vaccine if not used within 30 minutes
Administration
  • Intramuscular (IM) injection into the deltoid region of the upper arm, with a 1- to 1.5-inch needle
  • Subcutaneous (SQ) injection into the upper outer triceps area, with a 5/8″ needle
Dosage
  • 2-dose series, spaced 2 to 6 months apart
  • 0.5ml /dose
  • Arrange appointment/remind patient of second dose
  • Single dose
  • 0.65ml / dose
Recommended  groups
  • 50 years and older, immunocompetent adults
  • Those who previously had shingles or got Zostavax
  • Shingrix is the preferred shingles vaccine
  • 60 years and older, immunocompetent adults
  • Those who previously had shingles
  • May be used, for example, if a person prefers Zostavax or requests immediate vaccination and Shingrix is unavailable
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