Herpes Zoster: Talking Points on the New Vaccine for Patients

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Herpes zoster, also known as zoster or, more commonly, shingles, is caused by the reactivation of the varicella-zoster virus, the same virus that causes varicella (chicken pox). An estimated 1 million cases (1 in 3 Americans affected) of herpes zoster occur in the United States annually. The incidence among people 60 years and older is about 10 cases per 1000 individuals in the US population annually and is gradually increasing. Groups at greatest risk for developing herpes zoster are US adults over 50 years and immunosuppressed or immunocompromised individuals.

The FDA and the CDC’s Advisory Committee on Immunization Practices (ACIP) recently approved and recommended Shingrix (Zoster Vaccine, Recombinant Adjuvanted), manufactured by GlaxoSmithKline, for prevention of herpes zoster in patients 50 years and older. Shingrix is a refrigerated reconstituted, adjuvanted, inactivated 2-dose vaccine given at 0 and 2 to 6 months intramuscularly. Clinical trials have demonstrated greater than 90% efficacy in patients 50 years and older. Common adverse effects observed were local site reactions (redness, pain, and swelling) and general adverse reactions (myalgia, fatigue, and headache).

ACIP recommends that immunocompetent adults 50 years and older be vaccinated with Shingrix to prevent herpes zoster and related com- plications. In addition, ACIP prefers Shingrix over zoster vaccine live.

PATIENT TALKING POINTS

Pharmacists should discuss with their patients the following risks of developing shingles, the best way for patients to protect themselves against this vaccine-preventable disease, and adverse reactions of the vaccine and how to best manage them:

Shingles disease risk

• One in 3 people will develop shingles in their lifetime.
• Anyone who has had chicken pox can get shingles.
• Ninety-nine percent of people 50 years and older are at risk of developing shingles.
• The risk increases with age, especially after age 50.

Efficacy

• A new shingles vaccine is available with 90% efficacy against shingles in patients 50 years and older.
• The best way to protect yourself is to be vaccinated with the shingles vaccine.

Adverse reactions

• Nearly 80% of patients experienced local pain or redness. Therefore most patients will experience local site reactions (redness, pain, and swelling) and may experience general adverse reactions (myalgia, fatigue, and headache).
• Pharmacists should counsel every patient on these potential adverse effects and how to best manage them.

PATIENT ENGAGEMENT

Most patients will visit their local pharmacy more often than their primary care provider’s office. The pharmacist is in a key position to assess and communicate about a patient’s specific vaccine needs. Pharmacists will need to use a team approach to improve the likelihood of adult vaccine awareness. Pharmacy technicians should be trained to regularly ask patients for updates to their immunization history at the prescription drop-off window. The technician can refer patients to consult with the pharmacist about their specific vaccination needs. Student pharmacists and interns can assist with reviewing patient profiles during dispensing activities to identify patients who may be eligible for a vaccination(s) and assist with providing recommendations to patients. Pharmacists should routinely assess a patient’s vaccination needs to ensure they are up-to-date with ACIP recommendations. The pharmacist can use patient care opportunities, such as medication therapy and disease management consultations, to recommend necessary vaccinations.

VACCINE SERIES COMPLETION REMINDERS

Because the Shingrix vaccine is a 2-dose series, pharmacies will need to develop solutions to remind patients when they are due for their next vaccine dose in order to increase patient adherence. Consider creating a patient takeaway that reminds the patient when their next dose is due. Another option to consider is creating a patient call list, identifying patients who are due for their next dose in the vaccine series and performing reminder calls to increase adherence.

Pharmacists should also suggest that their patients create a calendar entry in their smartphone to remind them to return for their second dose in 2 to 6 months, while emphasizing the importance of completing the vaccine series to be fully protected.

PHARMACISTS’ ROLE AS IMMUNIZATION PROVIDERS

Pharmacists are considered an important component within the immunization neighborhood and should stay up-to-date on immunization guidelines and recommendations. In addition, pharmacists are urged to follow the immunization practice standards established by the National Vaccine Advisory Committee. Pharmacists should assess the immunization status of patients at each encounter and ensure that they are routinely reviewed. Industry studies have shown that patients are more likely to receive an immunization when pharmacists make a strong recommendation. After pharmacists assess patients’ immunization needs, pharmacists should then make strong recommendations on the immunizations that patients need while addressing any questions and concerns patients may have about receiving an immunization. If the patient accepts the pharmacist’s recommendation, the pharmacist should administer the immunization and document the immunization in the patient’s profile or the state’s immunization registry. If a pharmacy does not stock immuniza- tions, pharmacists should refer their patients to another provider who stocks vaccines to meet patients’ immunization needs.

This is an exciting time for pharmacists as immunization providers because we now have an opportunity to protect patients with a more effective vaccine against shingles. We have a responsibility to educate and counsel patients about shingles and the best way to protect themselves against this vaccine-preventable disease.

Alex Novielli, PharmD, is senior manager of pharmacy operations (immunization services) at Walgreens in Deerfield, Illinois.

References

1. Shingrix [package insert]. Rixensart, Belgium: GlaxoSmithKline Biologicals; 2017.

2. Shingles (herpes zoster): vaccination. CDC website. cdc.gov/shingles/vaccina- tion.html. Accessed January 19, 2018.

3. Shingles (herpes zoster): clinical overview. CDC website. cdc.gov/shingles/ hcp/clinical-overview.html. Updated October 17, 2017. Accessed January 19, 2018.

4. Standards for adult immunization practice. CDC website. cdc.gov/vaccines/ hcp/adults/for-practice/standards/index.html. Updated July 19, 2017. Accessed January 19, 2018.