That herpes zoster (HZ) is a disease caused by reactivation of varicellazoster virus (VZV), which has a low mortality rate, but whose complications are a major problem, especially in severely immunocompromised individuals.
Currently in Andalusia it has started to do so Vaccination against shingles for people over 18 years of age con hematopoietic stem cell transplantation (HSCT)this is the population with the highest incidence of herpes zoster (160 cases per 1000 people in the 2-10 months after transplantation; 210 cases per 1000 people in the 5 years after transplantation), ie a risk 40 times higher than that general population.
if they meet one of the following two criteria:
– If they pass less than 24 months after transplantation.
– Regardless of the elapsed time of the TPH: if you are receiving immunosuppressive treatment or if you have developed graft-versus-host disease (GVHD).
Subsequently, with the availability of cans that Individuals 18 years and older with the following risk conditions: malignant blood diseases, transplantation of solid organs, solid tumors in chemotherapy, HIV infection, in treatment with JAK inhibitors.
These patients must be referred to the preventive medicine department of each patient’s referral hospital to begin the two-dose vaccination schedule.
That’s what it’s used for one of the two vaccines authorized in Spain against HZ, Shingrix (HZ/see below) by GSKan inactivated vaccine with glycoprotein E as antigen and adjuvanted with AS01B, which among its approved indications are those of individuals aged 18 and over with certain risk conditions that it is aimed at prevent shingles and postherpetic neuralgia.
The Department of Health and Family establishes the following preliminary indications for use of the HZ/su (Shingrix) vaccine, which will be expanded as more doses become available.
The pattern consists of two canswith an optimal interval between doses of at least 2 months.
can be considered a minimum interval of 4 weeks between both doses in severely immunosuppressed patients according to medical criteria.
Salud clarifies that this policy allows some flexibilitycan use a minimum interval of one month (an additional grace period of 4 days is allowed) and a recommended maximum of up to 6 months.
If for any reason the second dose is administered 24 days ago from the first dose, the dose should be repeated at least 4 weeks after the last dose. On the other hand, if the second dose is administered after an interval of more than 6 months, there is no need to resume the regimen.
Generally, Serological testing before or after vaccination is not recommended with herpes zoster vaccination.
These are the particular situations that may affect or raise doubts about the vaccination schedule:
– newer HSCT: It is recommended to wait at least 3 months post-transplant in case of autologous HSCT and 6 months in case of allogeneic HSCT before administering the first dose of Shingrix.
– Vaccination history with Zostavax:You must wait at least 5 years after the last dose of Zostavax before taking the first dose of Shingrix.
– History of Shingles: does not affect vaccination. In the event that it has appeared recently, it can be vaccinated when the person has recovered from the acute infection and has no active lesions. Individuals for whom it is indicated according to this instruction are immunocompromised and are at high risk of herpes zoster recurrence.
It is not necessary to perform varicella zoster serology before or after administration of this vaccine.
– People who have not had chickenpox or have not been vaccinated against chickenpox: If they do not have accurate information about this, they will be vaccinated, regardless of whether they have this history or not, since more than 95% of the adult population has had chickenpox, even if they do not remember it.
– People with negative serology for chickenpox: In those cases where Shingrix vaccine is indicated according to this directive (patients with HPT as per Section 2), the same procedure is continued, administering the two-dose regimen of Shingrix vaccine.
– Taking antivirals: The use of antivirals before, during or after vaccination with Shingrix will not affect this as the vaccine does not contain live virus, so its mechanism of action is not affected.
– Recent contact with a person with chickenpox or shingles: You can be vaccinated without waiting as long as you are well and there are no contraindications to the vaccination.
– Pregnancy: Administration during pregnancy is not recommended.
Before reconstitution of the Shingrix vaccine it should be store in the fridge, between 2ºC and 8ºC. It is recommended to keep it in its original packaging to protect from light and should not be frozen.
After reconstitution, the vaccine should be used immediately. If this is not possible, the reconstituted vaccine can be stored in a refrigerator (2°C to 8°C) for a maximum of 6 hours. If this time is exceeded, the vaccine should be discarded.
route of administration
The vaccine is administered by intramuscularly, preferably in the deltoid muscle and it can be carried out in the same vaccination act with other vaccines, e.g.
In these cases vaccinations should be administered at different anatomical sites. If they are to be administered at the same anatomical site, they should be at least 2.5 cm apart. If it is not given in the same vaccination course, there is no need to respect a minimum interval between Shingrix and the other vaccines.
Contraindications and precautions
The vaccine is contraindicated in:
– History of severe allergic reactionsB. anaphylaxis, to an active substance or one of the excipients contained in the vaccine.
– Hypersensitivity to the previous dose.
It should be noted as a precaution Postpone administration of Shingrix in case of:
– Moderate or severe acute illness with or without concomitant fever: as usual with other vaccines. A mild infection would not delay vaccination.
– coagulation disorders: The vaccine can be administered intramuscularly unless medically contraindicated due to the risk of bleeding. If the person is being treated to reduce the risk of bleeding, as is done in people with hemophilia, the vaccine should be given within a short time of treatment. Individuals on chronic anticoagulant therapy, including individuals receiving warfarin with adequate INR control and individuals whose last control was below the upper limit of the therapeutic range, can receive the vaccine intramuscularly. A fine needle (preferably 25G) should be used, followed by firm pressure without rubbing for at least 2 minutes. It is important to report the possibility of a hematoma at the injection site.
– pregnancy and breast feeding period: There are no data from the use of this vaccine in pregnant women and although animal studies indicate no harmful effects, the administration of Shingrix vaccine during pregnancy is not currently recommended. However, women of childbearing potential do not need to have a pregnancy test prior to vaccination.
In the case of administration to a woman whose pregnancy status is unknown, she must be informed that, in principle, no associated risks are to be expected, since it is an inactivated vaccine with no possibility of transmission to the mother or to evoke the fetus . It can be administered during breastfeeding, there is no need to suspend it.
– Recent SARS-CoV-2 infection: There are no medical contraindications to the administration of the Shingrix vaccine and there is no need to wait a specific time.
However, it is recommended that vaccination be postponed until clinical recovery has been achieved and recommended isolation days have been observed.