| Technically Speaking |
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| Monthly Column by Deborah Wexler, MD |
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| Technically Speaking is a monthly column written by IAC’s Executive Director Deborah Wexler, MD. The column is featured in The Children's Hospital of Philadelphia Vaccine Education Center’s (VEC's) monthly e-newsletter for healthcare professionals. Technically Speaking columns cover practical topics in immunization delivery such as needle length, vaccine administration, cold chain, and immunization schedules. |
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| Check out a recent issue of Vaccine Update for Healthcare Providers. The VEC e-newsletter keeps providers up to date on vaccine-related issues and includes reviews of recently published journal articles, media recaps, announcements about new resources, and a regularly updated calendar of events. |
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| TECHNICALLY SPEAKING |
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| CDC Publishes Updated Guidance on the Use of Zoster Vaccines |
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| Published
February 2018 |
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A new vaccine for the prevention of herpes zoster was licensed by
the Food and Drug Administration in October 2017. Recombinant
zoster vaccine (RZV, Shingrix®; GSK) is a subunit vaccine that
contains recombinant varicella zoster virus glycoprotein E in
combination with a novel adjuvant (AS01B). Shingrix does not
contain live varicella zoster virus. It is approved for people 50
years and older and administered as a two-dose series with doses
separated by two to six months. Recommendations
Recommendations of the Advisory Committee on Immunization
Practices for Use of Herpes Zoster Vaccines was published on
Jan. 26, and is available on the MMWR website. The major
recommendations contained in this guidance are:
- Shingrix is recommended for the prevention of herpes zoster
and related complications for immunocompetent adults 50 years of
age and older.
- It is recommended for the prevention of herpes zoster and
related complications for immunocompetent adults who previously
received zoster vaccine live (ZVL, Zostavax®; Merck).
- Zostavax remains a recommended vaccine for prevention of
herpes zoster and its complications in immunocompetent adults 60
years of age and older. However, Shingrix is preferred over
Zostavax in this age group.
Storage and administration
There are several important differences between Shingrix and
Zostavax that staff must understand to avoid storage and
administration errors.
Shingrix
- Must be stored in the refrigerator only. If the lyophilized
vaccine, the adjuvant solution, or the reconstituted vaccine is
frozen, it must be discarded.
- Must be reconstituted only with the adjuvant liquid
suspension that is provided. After reconstitution, administer Shingrix immediately by the intramuscular route or store the
reconstituted vaccine refrigerated between 2° and 8°C (between
36° and 46°F) and use within 6 hours. Discard reconstituted
vaccine if not used within 6 hours or if
frozen.
- Is administered intramuscularly (IM). It should not be
administered subcutaneously. However, CDC has advised that a
dose administered by the subcutaneous route does not need to be
repeated.
Zostavax
- Must be stored in a freezer at a temperature of between -50°C and
-15°C (between -58°F and +5°F) until it is reconstituted. The
diluent should be stored separately at
room temperature or in the refrigerator.
- May be stored at refrigerator temperature between 2°C and 8°C
(between 36°F and 46°F) for up to 72 continuous hours prior to
reconstitution. Zostavax stored
between 2°C and 8°C that is not used within 72 hours of removal
from a freezer should be discarded.
- Is to be administered subcutaneously (Subcut) immediately after
reconstitution to minimize loss of potency. If the vaccine is not
administered within 30 minutes of
reconstitution, it must be discarded.
Related resources
CDC and manufacturer resources
IAC resources
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ACIP Recommendations
Vaccine Information Statements 
