Shingles vaccine is now recommended in Australia for people aged ≥18 years who are immunocompromised

[CLLerinOz]

The Australian Government recently updated its advice about vaccination against shingles.

The bad news is that the only vaccine funded through the National Immunisation Program is still Zostavax.

"Zostavax® is funded under the National Immunisation Program (NIP) at 70 years of age. Shingrix® is not currently funded under the NIP."

CLL patients SHOULD NOT receive the live vaccine Zostavax. Their only vaccination option is Shingrix. It is a 2-dose vaccine and costs approximately $250-300 per dose. A rebate is available for Shingrix from some private health funds depending on a person's cover.

The good news is that the recommendation to get vaccinated against shingles now covers those people aged ≥18 years who are immunocompromised.

The advice also recommends shingles vaccination for those aged ≥50 years who are household contacts of a person who is immunocompromised.

immunisationhandbook.health...

I've updated our pinned vaccinations post with a link to the updated information. It provides more information about Shingles and the reasons why getting vaccinated against it is such a good idea.

healthunlocked.com/cllsuppo...

(This is an unlocked post so those outside our community can also find it and read it on the internet. If you have CLL or care for someone with CLL and you are not yet a member, please consider joining our CLL Support community on Health Unlocked: healthunlocked.com )

[janvog]

At 87 I took the two injections of Shingrix. No problem reaction. I had shingles ten years ago: Terrible and permanent "postherpetic neuralgia". Get the Shingrix !

[bennevisplace]

I had my first shot of Shingrix yesterday. I figured I have nothing to lose, but with IGs (at the last count) still well below their reference ranges, probably not a lot to gain either. Do you know, is there something in the design of Shingrix to enhance the immune response in its target clientele, i.e. the immune-deficient?

[CLLerinOz Administrator in reply to bennevisplace]

Good question. As I didn’t know, I went looking for an answer and found this paper:

”Understanding the immunology of Shingrix, a recombinant glycoprotein E adjuvanted herpes zoster vaccine

Abstract - Herpes zoster is common in older and immune suppressed persons due to diminished VZV-specific cellular immunity. A recombinant herpes zoster vaccine (RZV) consisting of a single VZV glycoprotein and an adjuvant system stimulates robust and persistent VZV-specific antibody and CD4+ T cell responses in these high-risk populations. VZV-specific immune responses induced by RZV, including the generation of polyfunctional T cells, are driven by the synergistic actions of the components of the vaccine adjuvant system. RZV provides unprecedented protection against herpes zoster in older adults regardless of age at vaccination and is efficacious in immune suppressed populations. Adjuvanted subunit antigens may represent a general strategy for vaccines in the elderly and other individuals typically considered immunologically resistant to vaccination.”

Heineman TC, Cunningham A, Levin M. Understanding the immunology of Shingrix, a recombinant glycoprotein E adjuvanted herpes zoster vaccine. Curr Opin Immunol. 2019 Aug;59:42-48. doi: 10.1016/j.coi.2019.02.009. Epub 2019 Apr 17. PMID: 31003070.

pubmed.ncbi.nlm.nih.gov/310...

That was written in 2019 before mRNA vaccines started to dominate the discussion.

CLLerinOz

[bennevisplace in reply to CLLerinOz]

Thank you kind sir(?) I found a free, full text version of that paper here edisciplinas.usp.br/pluginf... wherein:

Hematologic malignancies

Patients (n = 562) received two doses of RZV or placebo separated by 1 or 2 months, with vaccine administration 10 days before or after chemotherapy or at 10 days to 6 months after cessation of therapy. A post-hoc analysis demonstrated that RZV provided 87% efficacy for the prevention of HZ with a median follow-up of 11 months [32]. Vaccine-specific antibody responses occurred in 65–80% of participants, depending on the type of malignancy and treatment; the mean peak fold-rise was 16. gE-specific CMI responses were present in 84% of RZV recipients with a 30-fold increase in median gE-specific CD4+ T cell frequencies.

No matter the conflicts of interest, the stuff seems to work in most blood cancer patients! I've had the strongest reaction to a vaccine in years, as in feeling rough all day today, which may be sign of the immune system stirring...

[CLLerinOz Administrator in reply to bennevisplace]

Hope you're feeling better tomorrow.

CLLerinOz 👩

[bennevisplace in reply to CLLerinOz]

Thanks, I am.