Overview:
The recombinant and adjuvant Zoster vaccine is indicated to prevent varicella Zoster (shingles). The Food and Drug Administration approved the vaccine in 2017 for administration to adults above 18. The most common complication of varicella zoster is post-herpetic neuralgia. The recombinant Zoster vaccine is more effective against post-herpetic neuralgia than live Zoster vaccine. Another advantage of the recombinant Zoster vaccine is that it is inactivated and can be administered even to immunosuppressed individuals. In contrast, live Zoster vaccine is a live-attenuated vaccine and cannot be administered to those weak individuals. Therefore, this article ultimately deals with the recombinant Zoster vaccine.
How Does a Zoster Vaccine Work?
The Zoster vaccine protects against herpes infection by boosting the immune response against the varicella-zoster virus.
Uses:
The Zoster vaccine prevents herpes zoster infection in adults aged 18 years and above and individuals at risk of herpes zoster due to immunosuppression caused by any disease or therapy.
Dosage and Schedule:
A single dose vial contains 0.5 ml. Two doses of the vaccine must be administered according to the schedule. The second dose must be administered two to six months after the first dose. But, for immunosuppressed individuals, the vaccination schedule is shorter, with a gap of one to two months after the first dose.
Warnings:
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Allergic Reactions: The patients are assessed for any previous history of vaccine-related allergic reactions before administration of the vaccine.
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Syncope: It is common for many individuals to experience syncope after vaccination.
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Guillain-Barre Syndrome: Some patients in a clinical study were found to have an increased risk of Guillain-Barre syndrome following the administration of a recombinant Zoster vaccine.
For Patients:
Learn About Shingles:
Shingles, also known as herpes zoster, are caused when the varicella-zoster virus-causing chicken pox in childhood gets reactivated. The varicella-Zoster virus becomes dormant after the resolution of chicken pox in the dorsal root ganglion of the central nervous system. The virus is reactivated and descended from the nerve cells to the skin surface when an individual’s immune system weakens. This causes painful cutaneous blisters. The complications associated with shingles are post-herpetic neuralgia, nerve palsy, and the spread of rash to the ears and eyes.
Learn About Zoster Recombinant Vaccine:
When and How Often to Take a Zoster Recombinant Vaccine?
A recombinant Zoster vaccine can be taken after 18 years of age. The vaccine is administered in two doses, and the second dose is scheduled after two to six months after the first dose.
How Effective Is Zoster Recombinant Vaccine?
On comparing the effectiveness of the recombinant Zoster vaccine and live Zoster vaccine through clinical trials, the recombinant Zoster vaccine is 90 % more effective in adults in preventing post-herpetic neuralgia.
Things to Inform The Doctor Before Vaccination:
The doctor must be informed about the following history before vaccination.
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Vaccination-allergy.
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Human immunodeficiency virus (HIV).
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Recent chicken pox episode.
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Chemotherapy or radiation therapy for cancer.
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Pregnancy.
How to Take a Zoster Recombinant Vaccine?
A recombinant Zoster vaccine can be administered only by a healthcare provider. Hence reach a local hospital to get vaccinated after 18 years of age.
Things to Do After Vaccination:
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Note the date of vaccination and set an alert for the second dose to avoid missing the dose.
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Look for side effects, such as pain, swelling, redness at the injection site, muscle pain, headache, fever, shivering, nausea, tiredness, and stomach pain. These side effects usually resolve after two to three days. If they are severe and chronic, visit a healthcare provider.
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The second dose can be taken even if the symptoms are present.
Dietary Alterations:
There is no accurate information on food interaction with the recombinant Zoster vaccine. Therefore, it is better to consult a physician beforehand to know what to do and what not to do before vaccination. In addition, avoid tobacco and alcohol before and after vaccination.
What Should Be Done When the Second Dose Is Missed?
The second dose of the recombinant Zoster vaccine must be taken two to six months after the first dose. If missed, the dose can be administered immediately without starting a new vaccination series.
How to Store Zoster Recombinant Vaccines?
The recombinant Zoster vaccine is supplied in two vials: one containing glycoprotein E powder and another containing adjuvant liquid suspension. These vials are stored at around 36 degrees Fahrenheit. Therefore, they must be stored away from light and not allowed to freeze.
How to Dispose of Recombinant Zoster Vaccine?
The vaccine is administered after reconstitution. If the reconstituted mixture is stored for more than six months or frozen, it must be discarded in a sharps-disposal container.
Tips to Stay On Track:
The vaccination schedule has to be noted, and an alert or alarm has to be set to remind of the second dose to avoid missing the dose.
For Doctors:
Indication:
The Zoster vaccine is administered to prevent herpes Zoster infection in adults aged 18 years and above and individuals at risk of herpes Zoster due to immunosuppression caused by any disease or therapy.
Pharmacology:
Mechanism of Action:
The Zoster vaccine protects against herpes infection by boosting the immune response against the varicella-zoster virus. Glycoprotein E is the immunological component of the Zoster vaccine, found on the surface of the varicella-zoster virus. The anti-glycoprotein E antibodies are stimulated, which develops adaptive immunity on immune exposure to the glycoprotein E. The adjuvant system is added to enhance the immune response and for the vaccine to last long against herpes zoster virus.
Ingredients:
The reconstituted recombinant Zoster vaccine contains recombinant glycoprotein E antigen, sucrose, dipotassium phosphate, sodium dihydrogen dihydrate, polysorbate, liposomes, phosphate-buffered solution, potassium dihydrogen phosphate, disodium phosphate, sodium chloride, and water.
Toxicity:
The effect of a recombinant Zoster vaccine on fertility shows no significant results, and the mutagenic potential of the vaccine has yet to be established.
Warning and Precaution:
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Allergic Reactions: The patient must be assessed for any previous history of vaccine-related allergic reactions before administration of the vaccine, and adequate supervision and management of anaphylaxis are essential.
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Syncope: It is common for many individuals to experience syncope after vaccination. Similarly, syncope can occur after Zoster vaccination and can be accompanied by visual problems and tonic-clonic limb movements. Proper management facilities must be available to individuals prone to syncope to avoid falling injury and restore cerebral perfusion.
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Guillain-Barre Syndrome: Some patients in a clinical study were found to have an increased risk of Guillain-Barre syndrome (a syndrome characterized by tingling and weakness in hands and feet, eventually paralyzing the body) following the administration of a recombinant Zoster vaccine.
Dosage and Forms:
The Zoster vaccine is a suspension supplied as a single-dose vial (0.5 ml) of glycoprotein E with a vial of adjuvant suspension.
Reconstitution and Administration of the Vaccine:
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The Zoster vaccine is supplied in two vials that should be combined before administration. The glycoprotein E powder and the adjuvant suspension are reconstituted, turning into a pale brown liquid. The mixture should be checked for discoloration or particulate matter contamination before administration and should not be administered if there is any.
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The reconstituted vaccine must be administered intramuscularly within six hours after reconstitution.
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The vaccine is injected using a sterile needle and syringe in the deltoid region of the upper arm.
Contraindications:
The Zoster vaccine is contraindicated in the following cases.
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To prevent chicken pox.
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Individuals with weak immune systems due to HIV.
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Individuals with life-threatening allergic reactions to neomycin, gelatin, and other vaccine components.
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Individuals under radiation therapy or chemotherapy for cancer.
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Pregnant women.
What Clinical Studies Were Performed for Recombinant Zoster Vaccine?
The safety of the recombinant Zoster vaccine was evaluated in a placebo-controlled study including older individuals of age groups 50 to 59, 60 to 69, and more than 70 years. The individuals were assessed for a week, and a saline solution was used as a placebo. There were local and adverse effects noticed in the subjects. The local adverse effects include pain, redness, and swelling at the injection site, and the general adverse effects include myalgia, headache, fever, shivering, and gastrointestinal symptoms. In this study, the adverse reactions were lower in individuals above 70 years than in those between 50 and 69.
Drug Interactions:
1. The efficacy of the recombinant Zoster vaccine can reduce when combined with the following drugs.
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Azathioprine.
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Betamethasone.
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Bleomycin.
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Busulfan.
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Carbamazepine.
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Chloramphenicol.
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Cisplatin.
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Methotrexate.
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Melphalan.
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Zidovudine.
2. The combination of recombinant Zoster vaccine and Theophylline can cause increased serum concentration of Theophylline.
Vaccines Interactions:
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Individuals vaccinated with the chickenpox vaccine must wait around eight weeks to receive the recombinant Zoster vaccine.
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The recombinant Zoster vaccine can be administered with other live or inactivated vaccines as it is non-live and can be administered in different arms on the same day.
Other Specifications:
Recombinant Zoster Vaccine in Pregnant Women:
The data on recombinant Zoster vaccine affecting pregnancy is minimal. However, to be cautious, the vaccine is contraindicated during pregnancy, or the women are asked to postpone pregnancy plans during the vaccination period.
Recombinant Zoster Vaccine in Lactating Women:
The excretion of the vaccine in breast milk is not yet assessed. However, the benefits of breastfeeding and the mother's necessity for vaccines are considered.
Recombinant Zoster Vaccine in Pediatric Patients:
The effectiveness of the recombinant Zoster vaccine has yet to be established in individuals below 18 years of age.
Recombinant Zoster Vaccine in Geriatric Patients:
No significant differences were evident when the vaccine's effectiveness was checked among different age groups.
