February 22, 2018:
Action Alert: Report 2017 MIPS Performance Data by March 31
February 13, 2018:
Advisory 181 Tamiflu and it’s generic Change on the PDL
February 12, 2018:
The Advisory Committee on Immunization Practices recommendations for the newly licensed recombinant zoster vaccine (RZV), Shingrix, by GlaxoSmithKline for the prevention were published in the MMWR on January 26, 2018. Shingrix is a 2-dose vaccine containing recombinant glycoprotein E and an adjuvant (AS01B). RZV is approved for use in those >50 years for the prevention of shingles and its complications. Initial clinical trials of RZV show higher vaccine efficacy across all age groups compared to zoster vaccine live (ZVL), Zostavax. Please see the attached recommendations for detailed clinical guidance
Recombinant zoster vaccine (RZV) is recommended for the prevention of herpes zoster and related complications for immunocompetent adults ≥50 years.
RZV is recommended for the prevention of herpes zoster and related complications for immunocompetent adults who previously received zoster vaccine live (ZVL).
RZV is preferred over ZVL for the prevention of herpes zoster and related complications (see p 105 of the recommendations for rationale).
-Please Note: Care should be taken not to confuse the two different zoster vaccine formulations. RZV (Shingrix) is stored in the refrigerator and administered intramuscularly (IM). ZVL (Zostavax) is stored in the freezer and administered subcutaneously (SC).
-Reconstitution. Shingrix consists of a lyophilized vaccine which needs to be reconstituted with the liquid adjuvant.
-Schedule. 2 doses should be administeredIM at 0 and 2-6 months. The vaccine series need not be restarted if more than 6 months have elapsed since the first dose. The minimum interval between doses is 4 weeks and doses given at shorter intervals should be repeated.
Shingrix can be given regardless of: 1) prior receipt of varicella vaccine; 2) prior receipt of ZVL; and 3) prior history of herpes zoster. Do not screen for a history of varicella (verbally or via laboratory serology).
–Timing of RZV for persons previously vaccinated with ZVL. Age and time since receipt of ZVL may be considered to determine when to vaccinate with RZV. Studies examined the safety and immunogenicity of RZV vaccination administered ≥5 years after ZV); shorter intervals have not been studied. However, there are no data or theoretical concerns to indicate that RZV would be less safe or less effective when administered at an interval of <5 years. Clinical trials indicated lower efficacy of ZVL in adults aged ≥70 years; therefore, a shorter interval may be considered based on the recipient’s age when ZVL was administered. Based on expert opinion, RZV should not be given <2 months after receipt of ZVL.
–Coadministration with Other Vaccines. CDC’s general best practice guidelines for immunization advise that recombinant and adjuvanted vaccines, such as RZV, can be administered concomitantly, at different anatomic sites, with other adult vaccines. Administration of RZV and adjuvanted influenza vaccine (Fluad), either concomitantly or at other intervals, has not yet been evaluated.
–Reactions. Studies show Shingrix is safe. Shingrix contains an adjuvant to improve immune response, so it can be associated with more temporary side effects than some other vaccines. About 16% of those vaccinated reported reactions that might prevent them from doing regular activities. Local reactions were reported in about 9% of recipients and systemic reactions in 11%, which included fatigue, fever, nausea, vomiting, diarrhea, shivering. The most common symptoms were pain (78%), myalgia (45%) and fatigue (45%). However, they resolve in 2-3 days.
–Counseling for Reactogenicity. Before vaccination, providers should counsel RZV recipients about expected systemic and local reactogenicity. Reactions to the first dose did not strongly predict reactions to the second dose; vaccine recipients should be encouraged to complete the series even if they experienced a reaction to the first dose of RZV.
Storage and Handling
Shingrix should be stored in the refrigerator at 2-8⁰C (not in the freezer). After reconstitution, it must be used within 6 hours or be discarded.
Resources for Healthcare Professionals and Patients
CDC has updated its shingles vaccination websites to reflect the new recommendations:
Shingles vaccination main page
What everyone should know about Shingrix
Information about Shingrix for Healthcare Professionals
November 20, 2017:
AAFP Family Medicine Board Review Express® Live Course in Baltimore, MD, March 8–11 Click here »
October 6, 2017:
Making available to MDAFP members, the Highlight on Vaccinations 4 Teens Resource Library which was distributed to participants at the HOV4T educational event on October 3, 2017 in Columbia, MD. Click here »
Anyone interested in receiving the presentations from the event may request one or more by contacting the MDAFP office at email@example.com or call 410-747-1980.
Presentation titles are:
- HPV vaccine implementation in the United States
- Vaccine Counseling Strategies
- Increasing Immunization Rates in Maryland: School Health Challenges and Opportunities