Shingrix vaccine (RZV - Recombinant zoster vaccine) stimulates active immunity against varicella-zoster virus.

It prevents a person from developing shingles and the complications associated with its such as post-herpetic neuralgia. It has an efficacy ranging from 91 to 97% depending on the age and the immune status of the patient.

When to use the Shingrix vaccine (RZV)?

• In patients 50 years of age and above, it is used to prevent herpes zoster (shingles).
• For immunocompetent adults 50 years of age and older, the ACIP (Advisory Committee on Immunization Practices) suggests routine vaccination, including
  • people who have already gotten the varicella vaccination or the zoster live vaccine
  • who have a history of Herpes-Zoster outbreaks
  • Patients with long-term illnesses such chronic lung disease, diabetes mellitus type 2, rheumatoid arthritis, and chronic kidney failure.
• In immunocompetent patients, the recombinant zoster vaccination (Shingrix vaccine) is preferred to the live zoster vaccine.
• Herpes zoster, postherpetic neuralgia, and the prevention of primary varicella infection are not indicated uses for it.

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Shingrix Vaccine (RZV) Dose in Adults

Shingrix Vaccine Dose in the prevention of Shingles in adults 50 years of age or more:

• 0.5 ml given intramuscularly over the course of two doses, 0 and 2 to 6 months after the initial dose.

• CDC/ACIP Shingrix Vaccine recommendations:

  • The initial series of immunisation shouldn't be restarted from scratch if it is postponed or interrupted.
  • The second dose should be given again if there is less than four weeks between the first and second doses.

Shingrix Vaccine (RZV) use in Children:

The safety and efficacy of the vaccine in children have not been established.

Pregnancy Risk Factor: C

• The ACIP advises pregnant women to postpone getting the zoster vaccine until after birth. The amount of information regarding its efficacy is limited.

RZV use during breastfeeding:

• It is unknown whether the components of vaccines are excreted into breastmilk.
• Administration of recombinant vaccines typically has no effect on the mother's or the child's ability to safely breastfeed.
• Manufacturers recommend that you weigh the benefits and risks to both the mother and infant.
• ACIP recommends that breastfeeding mothers delay recombinant-zoster vaccinations due to the absence of data.

RZV (Shingrix Vaccine) dose in renal impairment:

The manufacturer has not provided any adjustment in the dose in patients with renal disease.

Shingrix Vaccine dose in liver disease:

The manufacturer has not provided any adjustment in the dose in patients with liver disease.

Common Side Effects of Shingrix Vaccine (RZV):

• Central Nervous System:

  • Shivering
  • Headache
  • Fatigue

• Gastrointestinal:

  • Gastrointestinal Adverse Effects

• Local:

  • Pain At Injection Site
  • Erythema At Injection Site
  • Swelling At Injection Site

• Neuromuscular & Skeletal:

  • Myalgia

• Miscellaneous:

  • Fever

Less common Side Effects of Shingrix Vaccine (RZV):

• Central Nervous System:

  • Dizziness
  • Malaise
  • Chills

• Dermatologic:

  • Injection Site Pruritus

• Gastrointestinal:

  • Nausea

• Neuromuscular & Skeletal:

  • Arthralgia

Contraindications to Shingrix Vaccine (RZV):

• Severe adverse responses to any recombinant vaccination or formulation ingredient.

Warnings and precautions

• Anaphylactoid reactions and hypersensitivity reactions

  • The immunisation clinic should have immediate treatment (including epinephrine 1 mg/mL) ready due to the possibility of anaphylaxis and severe allergic responses.

• Syncope

  • Syncope can occur in young adults and adolescents especially after an injection.
  • To avoid syncope, the vaccine should be administered in a sitting or semi-recumbent position.
  • After the administration of the medication, there have been reports of seizures, syncope, and secondary injuries (skull fractures, cerebral hemorrhage).

• Acute illness:

  • Anyone who has an acute sickness shouldn't receive the immunisation.
  • Although it can be administered in mild cases, it is best to give the vaccine within 2 weeks of symptom onset.

• Infection of the zoster

  • Active zoster infections and postherpetic neuralgia are not approved uses.
  • Patients with active zoster should not receive the vaccine until symptoms have resolved and the acute illness has passed.

Monitor:

• Observe the patient for allergic reactions and syncope for 15 minutes following administration of the vaccine.
• If the patient develops hypotension, syncope, or has a seizure-like activity, he should be kept in a supine or Trendelenburg position to reestablish adequate cerebral perfusion.

How to administer Shingrix Vaccine (RZV - Recombinant zoster vaccine)?

• The deltoid muscle receives an intramuscular injection of it.
• The vaccination should not be combined with other vaccines or drugs; it should be given as a single shot.
• The recombinant zoster vaccine should not be administered within two months of the live zoster vaccine.
• When administering the vaccine, make sure the patient is seated or in a semirecumbent position so as to avoid vaccine-associated syncope that may result in a fall and subsequent head injury.
• Patients who are at risk of bleeding, such as those with hemophilia, should get the vaccine after the administration of the appropriate factors.
• After delivering the vaccination without rubbing the site, a tiny gauge needle (23 gauge needle) should be used, and firm pressure should be applied for at least two minutes.
• The patient should be urged to watch the injection site and should be made aware of the possibility of hematoma formation.

Mechanism of action of RZV (Shingrix Vaccine):

• RZV vaccine promotes active immunity to the varicella-zoster virus.
• It helps prevent shingles from occurring and also the complications that can arise, such as post-herpetic neuralgia.
• RZV decreased the chance of developing shingles by 97% for those between the ages of 50 and 70 and by 91% for people over the age of 70, according to clinical research.
• Patients aged 70 and older were also able to avoid PHN (post-herpetic neurolgia).
• The RZV (Shingles vaccination) is effective for approximately 4 years. It has an efficacy rate of between 85% and 93% after 4 years.

International Brands of RZV (Recombinant Zoster Vaccine):

• Shingrix vaccine

Recombinant Zoster vaccine (RZV) brands in Pakistan:

• Shingrix Vaccine (GSK - Recombinant Zoster Vaccine)
• Price: 45000 PKR