Herpes zoster vaccine recommendations for immunocompromised people

The WA Department of Health reminds GPs the Australian Immunisation Handbook has recently been updated to provide information on Shingrix, and to expand recommendations for immunocompromised adults.

There are two vaccines for the prevention of shingles: Zostavax, a live-attenuated vaccine, and Shingrix, a subunit (non-live) vaccine. Shingrix is the preferred vaccine due to higher efficacy but is currently only available as a private prescription. Zostavax is funded under the National Immunisation Program (NIP) at 70 years of age. The catch-up program for people aged 71-79 years has been extended for a further 2 years to 31 October 2023.

A single dose of Zostavax is an effective alternative to Shingrix in people who are immunocompetent. However, as Zostavax contains live attenuated varicella zoster virus it is not recommended in people who are immunocompromised or shortly expected to be immunocompromised. It is contraindicated in people who are considered severely immunocompromised. People aged ≥18 years who are immunocompromised or shortly expected to be immunocompromised are recommended to receive a 2-dose schedule of Shingrix.

Severe immunocompromise may be from either a primary or acquired medical condition, or medical treatment. Administering Zostavax to people who are severely immunocompromised can result in disseminated vaccine virus disease. Fatalities due to disseminated disease have followed administration of Zostavax to immunocompromised patients. Vaccine Administration Errors (VAEs) and serious adverse events have been reported in Western Australia.

The individual’s immune status should be carefully assessed before administering Zostavax, to confirm that they are not immunocompromised. If the person’s immune status is uncertain, do not administer Zostavax, and consult the person’s specialist or an immunisation specialist before proceeding.

All Zostavax VAEs, regardless of whether or not they result in an adverse event, should be reported to the Western Australian Vaccine Safety Surveillance (WAVSS) system at www.safevac.org.au