MMWR Update for Zoster Vaccine

 

Dear Immunization Partners,

The Centers for Disease Control and Prevention (CDC) published updated information on Zoster vaccine in the MMWR (Morbidity and Mortality Weekly Report) on January 21, 2022 titled, Use of Recombinant Zoster Vaccine in Immunocompromised Adults Aged ≥ 19 Years: Recommendations of the Advisory Committee on Immunization Practices-United States, 2022

On October 20, 2021, the Advisory Committee on Immunization Practices (ACIP) unanimously approved the recommendation of 2 doses of Zoster Vaccine Recombinant, Adjuvanted (Shingrix, recombinant zoster vaccine [RZV]) for the prevention of herpes zoster and related complications in adults aged ≥19 years who are or will be immunodeficient or immunosuppressed because of disease or therapy.  With moderate to high vaccine efficacy and an acceptable safety profile, RZV has the potential to prevent considerable herpes zoster incidence and related complications.

Clinical Guidance:

• Administer 2 RZV doses 2-6 months apart, regardless of previous history of herpes zoster disease or previous receipt of live zoster vaccine or persons who are or will be immunodeficient or immunosuppressed and who would benefit from a shorter vaccination schedule, the second dose can be administered 1–2 months after the first.
• Providers should vaccinate when the immune response is likely to be most robust for those that are immunocompromised.
• May be concomitantly administered with other adult vaccines utilizing different anatomic sites. Other adult vaccines include but are not limited to:
  • Influenza vaccine, 23-valent pneumococcal polysaccharide vaccine (PPSV23, Pneumovax23), tetanus toxoid, reduced diphtheria toxoid, acellular pertussis vaccine (Tdap, Boostrix), and COVID-19 vaccines.
• Providers need to counsel patients about expected local and systemic reactogenicity. Encourage patients to complete the series even if they experience reactions as long as they were nonanaphylactic reactions.

 

Special Populations:

• Persons with a history of herpes zoster should receive RZV.  Herpes zoster can recur. If a person is experiencing an episode of herpes zoster, vaccination should be delayed until the acute stage of the illness is over and symptoms abate.
• Persons who have neither experienced varicella nor received varicella vaccine are not at risk for herpes zoster. RZV is not indicated and has not been studied for the prevention of varicella.
• For immunocompromised persons, evidence of immunity to varicella (confirming need for RZV) includes documented receipt of 2 doses of varicella vaccine, laboratory evidence of immunity or laboratory confirmation of disease, or diagnosis or verification of a history of varicella or herpes zoster by a health care provider. For immunocompromised adults with no documented history of varicella, varicella vaccination, or herpes zoster, providers should refer to the ACIP varicella vaccine recommendations for further guidance, including postexposure prophylaxis guidance.

Resources:

Link to the MMWR:  Use of Recombinant Zoster Vaccine in Immunocompromised Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022 | MMWR (cdc.gov)

Current State of Michigan Vaccine Information Statement (VIS):  Zoster/Shingles Recombinant (RZV) - Vaccine Information Statement (VIS) (michigan.gov) *

*The Vaccine Information Statement (VIS) has not been updated to include the changes from this MMWR.  Watch for an updated version on the MDHHS website coming soon.  MDHHS - Vaccine Information Statements (VIS) (michigan.gov)

Thank you for all you do to protect Michiganders from Vaccine-preventable diseases.

Oakland County Health Division, Immunization Action Plan