MEMO: Herpes Zoster Product Transition

TO:  Health Care Professionals Who Order & Store Publicly Funded Vaccine

FROM: Vaccine Preventable Disease program

REFERENCE: Herpes Zoster Product Transition

DATE:  October 2020

The Shingrix® vaccine will transition into Ontario’s publicly funded shingles immunization program later this month. Current evidence and expert recommendations from the National Advisory Committee on Immunization (NACI) indicate that Shingrix® vaccine is more effective than Zostavax® II for preventing herpes zoster infection and related complications. Specifically, overall vaccine efficacy was above 90% for herpes zoster incidence and 88-91% for the prevention of post-herpetic neuralgia and slower waning immunity. Primary care providers are encouraged to identify and offer the Shingrix® vaccine to their eligible patients.

How to Order Shingrix®    

• Place your order the week of Oct. 19, 2020 or thereafter to include with your monthly vaccine delivery using the General Vaccine Order Form for primary care providers or the Long–Term Care Vaccine Order Form

Eligibility for Shingrix®

See chart below for vaccine eligibility by age and missed doses:

• Seniors aged 65 to 70 years who received publicly funded Zostavax® II are not eligible for publicly funded Shingrix®
• Seniors outside the eligibility criteria can speak with their health care provider about getting the vaccine privately (i.e. through private insurance, out-of-pocket).
  • It is important to note that prior recipients of the Zostavax® II will derive additional protection from completion of the two dose series of Shingrix® given higher and more durable vaccine efficacy across age groups. 

Immunization Schedule

• Shingrix® is a 2 dose immunization series, with the second dose given 2-6 months after the first
  • NACI suggests that a 0,12 months dosing schedule may be considered to facilitate uptake of the second dose (e.g. through simultaneous administration with another vaccine such as annual influenza vaccination) given evidence of an acceptable safety profile and robust immune response
• Discretionary recommendations from NACI that may be considered for some individuals in some circumstances.
  • For patients who have previously been vaccinated with Zostavax® II, the interval between Zostavax® II and Shingrix® vaccination will depend on:
    • Age of vaccination with Zostavax® II (since vaccine efficacy decreases with age)
    • Time interval since Zostavax® II vaccination (since efficacy wanes after the first year)
  • NACI suggests re-immunization with 2 doses of Shingrix® at least one year post Zostavax® II administration due to rapidly declining Zostavax® II effectiveness after the first year post-vaccination
  • Patients with a prior episode of herpes zoster are still at risk of herpes zoster. NACI recommends waiting at least one year post herpes zoster prior to the administration of Shingrix®
• The need for a booster dose following the primary vaccination schedule has not been established

Immunization Delivery during COVID-19

• Take all opportunities to immunize and offer vaccines when combined with other visits. More than one vaccine product can be administered safely in the same visit and will not affect vaccine efficacy
  • Shingrix® may be administered concomitantly with, or at any time before or after, other inactivated vaccines or live vaccines using different injection sites and separate needles and syringes.
  • Shingrix® may be given at the same time as unadjuvanted seasonal influenza vaccine

Safety & Patient Education

• Shingrix® is a safe vaccine with serious adverse events rarely reported among immunocompetent individuals
• The most commonly reported adverse events are local reactions at the injection site, including injection site pain, swelling or redness
• Shingrix® is more reactogenic due to the adjuvant it contains, which induces a high cellular immune response and helps address age-related decline in immunity
• Other common events are myalgia and fatigue
• Most effects are mild to moderate and do not last longer than three days on average

Patient education is recommended prior to vaccine administration.

• Patients should be prepared to adhere to a two dose schedule for the Shingrix® vaccine (as efficacy and protection is unknown after only one dose) and to understand that they may experience more short term reactogenicity from the Shingrix® vaccine 
• For seniors who previously paid for Zostavax® II and want to receive publicly funded Shingrix®, discuss the risks and benefits of re-immunization according to the NACI recommendations and expert opinion

Returning Zostavax® II to Public Health

Existing supplies of Zostavax® II expire October 21, 2020. Return unused doses of Zostavax® II to Public Health by completing the Vaccine Inventory and Return Form. Instructions on returning vaccine can be found on our Excursions and Returns webpage.

More Information

• NACI statement on Updated Recommendations on the Use of Herpes Zoster Vaccines
• Summary of the NACI Update on Herpes Zoster Vaccines
• Transition to Publicly Funded Shingrix® Vaccine for Ontario’s Shingles (Herpes Zoster) Immunization Program: Information for Health Care Providers
• Visit Public Health’s immunization and vaccine web page for health care professionals or call the Vaccine Preventable Disease program at 905-688-8248 or 1-888-505-6074 ext. 7396