Zoster vaccine added to NIP


Those aged 70-79 can now freely access the vaccine, which aims to protect against shingles and related neuropathic pain

From 1 November, Australia’s only vaccine to protect against shingles and postherpetic neuralgia will be available on the National Immunisation Program (NIP) for people aged 70-79.

It has been added to the schedule due to incidence of shingles going up dramatically in this age group, said Professor Dominic Dwyer* from the University of Sydney.

“Shingles is an important disease in the elderly and rates are going up year-by-year,” says Professor Dwyer. “While the focus has usually been on children’s vaccination, there’s a big interest now in adult vaccination and it’s becoming really important.”

Zostavax is a single-dose, live attenuated vaccine that is administered subcutaneously in order to combat reactivation of the latent varicella-zoster virus, which is present in 97% of adult Australians.

“People may not understand that they are at risk of shingles. About one in three adults will have an episode of shingles in their lifetime, and it’s the pain associated with shingles rash that is the main clinical issue,” says Professor Dwyer.

In addition to rash, pain and nerve damage, there are other complications such as ophthalmic zoster and secondary bacterial skin infection. There is also an increased risk of stroke in the six months following a case of shingles.

Efficacy

A randomised double-blind placebo-controlled efficacy trial of nearly 40,000 adults found incidence of shingles in vaccinated individuals was reduced by 51% compared with placebo. There was also a reduction of postherpetic neuralgia by 67% compared with placebo.

According to the results, Zostavax is generally well tolerated, with the most common side effects including headache, erythema, pain/tenderness, swelling, pruritus, fatigue, haematoma, warmth, induration and pain in extremities.

Over 33 million shingles vaccinations have been distributed worldwide without any significant adverse events in clinical trials, Professor Dwyer points out.

Role of pharmacists

Since experts suggest the flu vaccination be concurrently administered with the zoster vaccine, could pharmacists be a part of shingles vaccination administration sometime in the future?

“Live attenuated vaccines are probably generally better done in general practices,” asserts Professor Dwyer.

“They can be problematic in the immunosuppressed – for example, those with HIV, or the transplant population.

“But that’s just my personal opinion and I’d be open to hearing what the pharmacy folk have to say about that.”

Pharmacist-vaccination advocate Dr Lisa Nissen argues that pharmacists are already appropriately trained to manage vaccines such as Zostavax.

“There is evidence already in a number of jurisdictions that pharmacists are capable of administering vaccinations to patients appropriately – with consideration of any of the risk factors you would expect a clinician to make.

“In QLD for example we are already able to administer measles vaccinations which is in this [live attenuated] category.

“The training pharmacists receive is not limited to influenza vaccines and the need to be cognisant of risks and contraindications is important across all vaccines, including for immunocompromised patient,” she says.

Another possibility is an up-and-coming vaccine that is not live attenuated and seems efficacious, but Professor Dwyer points out that it is still quite new and is not yet on the market.

For now, pharmacists should be aware of those at high-risk of developing shingles, he says.

“Let your patients aged 70-79 years know Zostavax available for free on the NIP. It is also available for those aged 50 and above, although those outside the 70-79 age group will need to pay for it.”

*Professor Dwyer presented at an event announcing the new product. He has previously served on advisory boards sponsored by vaccines business Seqirus, which manufactures Zostavax. However he states that in relation to this news announcement, no compensation was provided and the opinions expressed were his own.

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