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.

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 has 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

Contraindication 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 hemorhage).

• 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 symptoms 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 varicella-zostervirus.
• It helps prevent shingles from occurring and also the complications that can arise, such as post-herpetic neurogia.
• 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:

No Brands Available in Pakistan.