Episode #1: Shingrix - Too good to be true?

Disgruntled Dan's Conclusions  1) Shingrix – Reduces the incidence of Herpes Zoster Infections RRR of 97%; NNT of 36 over 3.7 years -Are the results too good to be true? -No long-term efficacy data yet.... 2) Shingrix – Requires 2 intramuscular injections spaced 2-6 months apart -Adherence may be an issue - will one dose be effective?  -Second dose can still be given outside of the 2-6 month window without restarting the series  3) As per the Advisory Committee on Immunization Practices it is safe to provide the Shingrix vaccine to those previously immunized with Zostavax – space a minimum of 8 weeks apart. -Can provide the flu vaccine simultaneously with Shingrix  4) No contraindication to providing Shingrix to the immunocompromised.  -Trials have been completed in HIV infected and haematopoietic stem cell transplant recipients and thus far have been shown to be safe but the clinical efficacy in these patient populations is yet to be evaluated. 5) Cost  -Shingrix ~$150/injection - ~$300 per series -Zostavax ~200+/injection   References  1) Morrison, V.A. et al. Long-term Persistence of Zoster Vaccine Efficacy. Clin. Infect. Dis. 60, 900–909 (2015). 2) Schmader, K. E. et al. Persistence of the Efficacy of Zoster Vaccine in the Shingles Prevention Study and the Short-Term Persistence Substudy. Clin. Infect. Dis. 55, 1320–1328 (2012). 3) Oxman, M. N. et al. A Vaccine to Prevent Herpes Zoster and Postherpetic Neuralgia in Older Adults. N. Engl. J. Med. 352, 2271–2284 (2005). 4) Cunningham, A. L. et al. Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older. N. Engl. J. Med. 375, 1019–1032 (2016). 5) Grupping, K. et al. Immunogenicity and Safety of the HZ/su Adjuvanted Herpes Zoster Subunit Vaccine in Adults Previously Vaccinated With a Live Attenuated Herpes Zoster Vaccine. J. Infect. Dis. 216, 1343–1351 (2017). 6) Lal, H. et al. Efficacy of an Adjuvanted Herpes Zoster Subunit Vaccine in Older Adults. N. Engl. J. Med. 372, 2087–2096 (2015). 7) Bharucha, T., Ming, D. & Breuer, J. A critical appraisal of ‘Shingrix’, a novel herpes zoster subunit vaccine (HZ/Su or GSK1437173A) for varicella zoster virus. Hum. Vaccin. Immunother. 13, 1789–1797 (2017). 8) GSK. Product Monograph: Shingrix. (2017). 9) Albrecht, M., Hirsch, M. & Mitty, J. Vaccination for the prevention of shingles (herpes zoster) - UpToDate. (2017). Available at: https://www.uptodate.com/contents/vaccination-for-the-prevention-of-shingles-herpes-zoster?search=shingles&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4. (Accessed: 19th February 2018) 10) Keilly, J., et al. Rx Files:A Summary Herpes Zoster Vaccine (ZOSTAVAX). 11) Canada. National Advisory Committee on Immunization & Public Health Agency of Canada. An advisory committee statement (ACS) - National Advisory Committee on Immunization (NACI) : update on the use of herpes zoster vaccine