Tuesday, February 20, 2024

Shingles Vaccine Second Dose Timing

Does Shingrix Cause Guillain

What happens if you dont get your 2nd vaccine dose on time?

Shingrix may be associated with an increased risk of Guillain-Barré syndrome, a rare nervous system disorder. The FDA required that the vaccine label be changed to include this information and reflect the potential risk of Guillain-Barré syndrome. A postmarketing observational study found that there may be an increased risk of Guillain-Barré syndrome during the 42 days following vaccination. Still, the FDA asserts the benefits of the vaccine outweigh the potential risk of adverse effects.

Very Common And Common Adverse Events

Very common adverse events occur in 10% or more of vaccinees. Common adverse events occur in 1% to less than 10% of vaccinees.

Injection site reactions are very commonly reported for both LZV and RZV. For LZV recipients the frequency is slightly higher in adults aged < 60 years. For all ages, the majority of these events were rated mild or moderate in intensity and lasted less than 2 days.

Due to the adjuvant in RZV, which induces a high cellular immune response and helps address the natural age-related decline in immunity, RZV is more reactogenic than LZV.

Injection site AEs are very commonly reported by recipients of RZV. Approximately 80% report injection-site pain and approximately 30% report redness at the site of injection.

Systemic adverse events, primarily fatigue and myalgia are common in LZV recipients and very common in RZV recipients . For RZV, they include headache .

Local and systemic reactions that were severe enough to interfere with normal activities have been more frequently reported following the receipt of RZV than LZV. However, these reactions have been temporary . Patient education on the short-term reactogenicity of the RZV is recommended prior to vaccine administration to promote adherence to the second dose.

Dose Route Of Administration And Schedule

Live attenuated zoster vaccine

Dose

Each dose is 0.65 mL .

Route of administration

Each dose is 0.5 mL .

Route of administration

Intramuscular, into the deltoid region of the upper arm.

Administration of the RZV as a subcutaneous injection is a vaccine administration error and should be avoided. However, if Shingrix is inadvertently administered subcutaneously, that dose will be considered as valid in the vaccine series. The second dose will be given as per vaccine schedule.

For more information, refer to Vaccine Administration Practices in Part 1.

Schedule

2 doses, 2 to 6 months apart. A 0,12 months schedule may be considered for improved adherence to the 2nd dose .

Providers should consider different strategies to promote adherence to the two dose schedule for RZV .

Read Also: What To Take For Nerve Pain From Shingles

The Biology Behind That Blistering Rash

During the initial exposure to chickenpox, some of the virus particles settle into the nerve cells around the spinal cord and brain. When the virus reactivates sometimes decades later, as a result of things like stress it travels down those nerve fibers to the skin. As the virus multiplies, the telltale rash erupts.

Who Should Not Get Zostavax

Vaccinations

Some people should not get shingles vaccine :

The Shingles Prevention Study involved individuals age 60 years and older and found that Zostavax significantly reduced disease in this age group. The vaccine is currently recommended for persons 60 years of age and older.

  • A person who has ever had a life-threatening or severe allergic reaction to gelatin, the antibiotic neomycin, or any other component of shingles vaccine. Tell your doctor if you have any severe allergies.
  • A person who has a weakened immune system because of:
  • HIV/AIDS or another disease that affects the immune system,
  • treatment with drugs that affect the immune system, such as steroids,
  • cancer treatment such as radiation or chemotherapy, or
  • cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma.
  • Women who are or might be pregnant. Women should not become pregnant until at least 4 weeks after getting shingles vaccine.
  • Someone with a minor acute illness, such as a cold, may be vaccinated. But anyone with a moderate or severe acute illness should usually wait until they recover before getting the vaccine. This includes anyone with a temperature of 101.3°F or higher.

    This information was taken from the Shingles Vaccine Information Statement dated 10/06/2009.

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    Are There Any Restrictions After A Shingles Shot

    You should not receive the shingles vaccine if you are pregnant, if you have an active shingles infection, or if you previously had an allergic reaction to any component of the vaccine. If youre eligible for the vaccine and receive the vaccination, there are no restrictions afterward and you can leave the doctors office or pharmacy as soon as the shot is complete.

    If Youre 50 Or Older Get Shingrix

    • Shingrix provides strong protection from shingles and long-term nerve pain.
    • Get Shingrix even if you already had shingles, because you can get the disease more than once.
    • Your risk of shingles and complications increases as you age.
    • You need 2 doses of Shingrix. Get the second dose 2 to 6 months after you get the first dose.

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    When To See A Doctor For The Possible Side Effects Of A Shingle Vaccine

    Most side effects of the shingles vaccine will resolve on their own within a few days of vaccination or can be treated with over-the-counter medications like acetaminophen or ibuprofen.

    In the rare case that you develop a more serious reaction after vaccination, you should call a doctor or go to a health clinic.

    Medical emergency

    Its rare but possible to have a serious allergic reaction to a shingles vaccine. Call emergency services or go to the nearest emergency room if you experience the following symptoms after a vaccination:

    What Else To Know About The Shingles Vaccine

    Yes, you can get the shingles vaccine after getting your COVID vaccine

    Ready to get vaccinated? This is the essential info on how the shots are given, what to expect with side effects, and more.

    You need two doses of Shingrix to get full protection from shingles. You should get your second dose 2 to 6 months after the first. Your doctor or pharmacist will inject the vaccine into the muscle of your upper arm, so wear clothes that give easy access to that area.

    If it has been more than 6 months since you got your first dose, go ahead and get your second dose. You donât need to start over, Dooling says.

    Because Shingrix is so new, experts arenât sure whether youâll eventually need another shot, or a booster, years down the road.

    âThe CDC is actively following how protected people remain after the two-dose series,â she says. We know that after 4 years, protection remains above 85%. Only time will tell how durable that protection is.â

    You do not have to wait between Shingrix and COVID-19 vaccination. The CDC has determined its safe to get the COVID-19 vaccine at the same time as Shingrex, but recommends they be given in different arms. You should not get eithe vaccine if you have COVID.

    Side effects are fairly common. You may have heard that people sometimes have unpleasant side effects soon after they get the shingles vaccine.

    âShingrix tends to have has more side effects than some vaccines, like those for the seasonal flu,â says Kistler. The shingles vaccine may cause:

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    Uncommon Rare And Very Rare Adverse Events

    Uncommon adverse events occur in 0.1% to less than 1% of vaccinees. Rare and very rare adverse events occur, respectively, in 0.01% to less than 0.1% and less than 0.01% of vaccinees.

    Both HZ vaccines are safe with serious adverse events reported very rarely in immunocompetent individuals.

    Recurrence or exacerbation of herpes zoster ophthalmicus following LZV vaccination has been reported very rarely, involving several cases world-wide following LZV immunization. Following a causality assessment of seven cases of HZO which were temporally associated with the administration of LZV, NACI concluded that there was insufficient evidence to recommend for or against the administration of LZV in individuals with a history of HZO. More evidence is required for further assessment of risk related to HZO recurrence in LZV recipients. At this time, there is insufficient evidence to assess the risk related to HZO recurrence following RZV recipients.

    See Contraindications and Precautions if considering vaccinating a person with previous HZO.

    For more information, refer to Adverse Events Following Immunization in Part 2 and the product monograph in Health Canada’s Drug Product Database.

    Skipping The Second Dose Of The Shingles Vaccine Might Mean You Have Less Protection Against This Painful Rash

    Medically reviewed in March 2021

    Shingles is a painful condition, and the effects of it can last for months or even years in some cases. Although there is no cure for shingles once you have it, there is a vaccine that prevents shingles in the first place.

    The Centers for Disease Control and Prevention recommends that healthy adults over the age of 50 get the shingles vaccine. This is true even if youve had shingles in the past, or if you were previously vaccinated with the older shingles vaccine.

    The shingles vaccine is administered in two separate dosesonce you receive the first dose, the second should be given 2 to 6 months later. After the second dose, the vaccine is more than 90 percent effective at preventing shingles, according to the CDC.

    Why the second dose matters The shingles vaccine is designed to be given as two doses, not as one. Despite the effectiveness of the vaccine, some people skip their second dose. Some simply forget to follow up and lose track of the appointment date. Others may skip the second dose due to costdepending on your insurance plan, you may be responsible for a co-pay or deductible fee, or you may need to pay for the second dose out of pocket.

    Getting the second dose gives you the full protection the vaccine offers. Below are some ways to make sure you get your second dose.

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    When Should I Get The Second Dose

    The CDC recommends that adults ages 50 and older get a second dose of Shingrix two to six months after their first dose. If youve waited longer than six months since your first dose of Shingrix, its safe to get a second dose right away. Most people dont need to repeat the first dose.

    Some immunocompromised adults may need a second dose within one to two months. If you have a disease or are taking medication that affects your immune system, talk to your healthcare provider about the best timeline for your two doses of the shingles vaccine.

    Counseling Patients About Shingrix

    Immunizations

    Know the benefits and side effects of Shingrix so youre prepared to talk with your patients before administering the vaccine.

    What to tell patients about Shingrix benefits:

    • You can protect yourself against shingles. Shingles is a very painful disease, and your risk of getting it increases as you age. Also, you are more likely to have severe, long-term pain if you get shingles when you are older. About 1 out of every 3 people in the United States will develop shingles in their lifetime.
    • Shingrix provides strong protection against shingles and long-term pain from the disease. Two doses of Shingrix are more than 90% effective at preventing shingles. So its very important that you get this vaccine.

    What to tell patients about Shingrix side effects:

    What to tell patients about dose two:

    • You need to come back in 2 to 6 months for your second dose. We can make that appointment now.
    • Even if you have side effects from the first dose, it is important to get the second dose to build strong protection against shingles. Your reaction to each dose may be different just because you have a reaction to the first dose does not mean that you will have a reaction to the second.

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    Who Is At Risk For Shingles Infection

    Although it can occur at any age, shingles is more common in older adults and in people with compromised immune systems. In fact, those who are immunocompromised are 1-6 times more prone to infection and have a significantly higher risk of recurrence.

    Even people with normal immune systems are at greater risk as they age. Because our immune systems tend to weaken as we get older, by age 50 many people previously infected with chickenpox will have lost the specific immunity they developed after the original infection. When this happens, the virus can wake up and trigger shingles. Some experts believe that chronic stress, some medications and certain health conditions may also trigger the virus to reactivate.

    In addition, people who have had COVID-19 are at increased risk. In a recent study, researchers have found that patients over 50 with a history of COVID-19 infection have a 15 percent higher risk of getting shingles, says Dr. Kumar.

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    Annexe A: Shingles Vaccine Information And Guidance For Healthcare Professionals

    This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: .

    Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

    This publication is available at https://www.gov.uk/government/publications/shingles-immunisation-programme-introduction-of-shingrix-letter/annexe-a-shingles-vaccine-information-and-guidance-for-healthcare-professionals

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    Other Vaccines On The National Immunisation Schedule

    All the vaccines can now be given at the same time or immediately before or after the COVID-19 vaccine. These include measles-mumps-rubella , influenza, human papillomavirus , tetanus and whooping cough vaccine , the Shingrix shingles vaccine, and meningococcal vaccines. Ask your health provider if there are any vaccines that you may have missed or are due to have while you get your COVID-19 vaccine.

    Pregnant women are recommended influenza vaccine and COVID-19 vaccine at any stage of pregnancy and whooping cough vaccine from 16 weeks gestation. They can be given at the same time or separately.

    Note that most of the dedicated COVID-19 vaccination centres do not have other vaccines available. Please ask your usual health provider if there are any other vaccines you need.

    How Well Does Shingrix Work

    How to handle the after effects of the 2nd vaccine dose

    Two doses of Shingrix provide strong protection against shingles and postherpetic neuralgia , the most common complication of shingles.

    • In adults 50 to 69 years old with healthy immune systems, Shingrix was 97% effective in preventing shingles in adults 70 years and older, Shingrix was 91% effective.
    • In adults 50 years and older, Shingrix was 91% effective in preventing PHN in adults 70 years and older, Shingrix was 89% effective.
    • In adults with weakened immune systems, Shingrix was between 68% and 91% effective in preventing shingles, depending on their underlying immunocompromising condition.

    In people 70 years and older who had healthy immune systems, Shingrix immunity remained high throughout 7 years following vaccination.

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    Why Do I Need Two Doses Of Shingrix

    In addition to a painful rash, shingles can lead to serious health complications like PHN, pneumonia, vision loss, hearing problems, and encephalitis . Research indicates that about 1% to 4% of people with shingles will be hospitalized.

    Two doses of Shingrix offer effective protection against shingles and related complications for at least seven years. Among healthy adults ages 50-69, Shingrix is more than 90% effective in preventing PHN when two doses are administered. Among adults ages 70 and older, it is 89% effective.

    Who Should Avoid Getting The Shingrix Vaccine

    You should not get Shingrix if you:

    • Have ever had a severe allergic reaction to any component of the Shingrix vaccine
    • Currently have shingles
    • Currently are pregnant or breastfeeding
    • Tested negative for immunity to varicella-zoster virus
    • Have a moderate or severe illness with a temperature of 101.3º F
    • Have gotten Varivax less than eight weeks ago

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    Who’s Most At Risk Of Shingles

    People tend to get shingles more often as they get older, especially over the age of 70. And the older you are, the worse it can be. The shingles rash can be extremely painful, such that sufferers cannot even bear the feeling of their clothes touching the affected skin.

    The pain of shingles can also linger long after the rash has disappeared, even for many years. This lingering pain is called post-herpetic neuralgia .

    Assessing Eligibility For Covid

    News

    As more people are coming through the doors of vaccine centres, so too are the range of individual circumstances and the queries we are seeing at the Immunisation Advisory Centre to confirm eligibility. The Immunisation Advisory Centre would like to take this opportunity to emphasise that in most cases, the vaccine is safe to deliver. Importantly, vaccination should not be delayed.

    It is safe to vaccinate: Pregnant women in any stage of pregnancy People with any medical condition or receiving any type of medical treatment. There are no medical conditions, past or current, or medicines that prevent a person receiving a COVID-19 vaccination. The vaccine is safe for people with compromised immune systems, however they may not have an immune response as strong as a healthy person and it is therefore important for those around them to also have the vaccine. People with history of anaphylaxis as long as it was not caused by the vaccine or something in the vaccine. Vaccinators will discuss this in detail at time of vaccination. People aged 12 years or over for the adult vaccine or 5-11 for the paediatric vaccine. People who are not competent to give consent can be vaccinated if the treatment is seen as in the best interest of the person see guidance set out in the Immunisation Handbook.

    For more detailed information please refer to the Immunisation Handbook.

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