Welcome to the CIC Education Hour

Transcription

1 Welcome to the CIC Education Hour

2 Shingles Vaccine 2.0: What you need to know

3 Objectives Explain the clinical benefits and recommendations for administration of Shingrix, the new shingles vaccine Explain the differences between Shingrix and Zostavax vaccines Create and/or implement effective messaging to staff and patients on the benefits of the new shingles vaccine

4 Questions for Presenters? Ask Questions Here

5 Frequently Asked Questions 1. Will I be able to get a copy of the slides after the webinar? Yes a copy will be posted on the ImmunizeCA.org site 2. Will I receive a copy of the webinar recording? Yes - a copy will be posted on the Immunize.org site

6 Mark Sawyer, MD, FAAP Professor of Clinical Pediatrics and Pediatric Infectious Disease Specialist UCSD School of Medicine and Rady Children s Hospital San Diego 6

7 Shingles Vaccine 2.0: What you need to know MARK H. SAWYER, MD UCSD/RADY CHILDREN S HOSPITAL SAN DIEGO SAN DIEGO IMMUNIZATION PARTNERSHIP

8 We have a problem! A disease that affects 1/3 of all adults A disease that is extremely painful A disease that can be debilitating for months A disease that we can prevent So why aren t we preventing this disease?!?!?!?

9 Zoster=Shingles

10 Disclosures I have no disclosures related to this presentation

11 Objectives Describe the impact of shingles on our population so that you can inform your patients Explain what is different about the new recombinant zoster vaccine (RZV) so that you can answer your patients (and family members) questions Explain why the new RZV has more local and systemic side effects so that you can warn your patients to expect them Apply the ACIP recommendations for use of RZV in different populations Recognize the challenges we face in increasing zoster vaccine coverage rates

12 WHAT IS ZOSTER? WHY DOES IT LOOK LIKE THAT? Zoster is your varicella/chickenpox coming back to haunt you Varicella virus remains latent in your spinal cord for decades Reactivation occurs when your immune system is suppressed, either naturally or because of disease or medication. Incidence rises with age About 15% of people who get zoster suffer from post-zoster neuralgia that can last for months or longer Zoster should become less common because we now prevent varicella in children through immunization 12

13 Dooling, ACIP Meeting, October 2017

14 Zoster is a worldwide problem Incidence rises dramatically with age Kawai, BMJ Open Access dx.doi.org/ /bmjopen

15 New subunit zoster vaccine (Herpes Zoster/su) Recombinant Zoster Vaccine (Shingrix) Licensed by FDA, October dose subunit vaccine Recommended by ACIP beginning at age 50 Preferred over the current live attenuated vaccine

16 NEW ZOSTER VACCINE Dooling, ACIP Meeting October

17 Two different zoster vaccines ZOSTER VACCINE LIVE (ZVL)-ZOSTAVAX Live virus vaccine Can t be used in people with compromised immune systems Stored frozen Given as a single dose subcutaneously Recommended routinely starting at age 60 years Recommended even if you have had zoster Overall effectiveness for the prevention of zoster=50% RECOMBINANT ZOSTER VACCINE (RZV/HZ- SU)-SHINRIX Recombinant subunit glycoprotein E vaccine Contains a novel adjuvant (ASO1 B ) Stored refrigerated Given as two doses intramuscularly, 2-6 months apart Recommended routinely starting at 50 years Recommended even if you have had zoster or received ZVL before Increased local side effects

18 Dooling, ACIP Meeting, October 2017

19 Dooling, ACIP Meeting, October 2017

20 Dooling, ACIP Meeting, October 2017

21 Dooling, ACIP Meeting, October 2017

22 Why does this vaccine work better?

23 The Immune system

24 Adjuvants and the immune system The immune system responds to some things better than others Live, replicating agents induce better immunity than inert subunit protein or carbohydrate (MMR>tetanus) Proteins are better than carbohydrates (PCV13>PPSV23) More complex formulations better than purified formulation (Whole cell pertussis>dtap) Certain molecule structures stimulate the immune system (Virus like particles [e.g.hpv vaccine]) Adjuvants Alum Liposomes Squalene Nanocarriers CpG oligonucleotides Lipid molecules LPS Natural toxins

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26 Adjuvants-concerns Enhanced local reactions Swelling Tenderness Redness Enhanced systemic reactions Fever Malaise Achiness Autoimmune reactions (theorhetical)

27 RZV local side effects

28 RZV systemic reactions

29 Dooling, ACIP Meeting, October 2017

30 RZV recommended routinely starting at the age of 50 years Should be given to persons with a history of zoster Should give to persons with chronic medical conditions and mile immunosuppression (e.g. <20 mg/day prednisone No specific recommendation for immunocompromised persons RZV can be given concomitantly with other vaccines Counsel your patients about local and systemic reactions Additional safety studies ongoing Could need to modify concomitant use of multiple adjuvanted vaccines (e.g. adjuvanted influenza vaccine-fluad, adjuvanted hepatitis B vaccine-heplisav) Not recommended for prevention of varicella Dooling, MMWR 2018;67:

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32 RZV recommended in people who have already received ZVL Interval not clearly specified RZV has been studied 5 years following ZVL No reason to be concerned about shorter intervals One reasonable consideration is the age of the patient when they received ZVL (decreased effectiveness in those >70 years of age Minimum interval following ZVL is 2 months Dooling, MMWR 2018;67:

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34 RZV recommended preferentially over ZVL Improved effectiveness and probably improved duration of protection ZVL is still available and can still be used

35 Our challenge

36 WE SHOULD BE DOING BETTER 33% of adults >60 years of age had received zoster vaccine in 2016 Dooling, ACIP Meeting, October 2017; MMWR 2018;67:

37 Barriers to delivering zoster vaccine Lack of awareness of zoster-associated morbidity Perceived lack of vaccine effectiveness Out of pocket expense/cost Part D Medicare coverage Harpaz, Vaccine 2017;35:

38 Improving zoster vaccine use Strong recommendation from providers Education about zoster and the new vaccine Enlist pharmacies to step up their efforts to immunize seniors Use reminder/recall systems including CAIR Advocate for a better Medicare coverage benefit

39 Comments and Questions?

40 Final Thoughts 40

41 Frequently Asked Questions 1. Will I be able to get a copy of the slides after the webinar? Yes a copy will be posted on the ImmunizeCA.org site 2. Will I receive a copy of the webinar recording? Yes - a copy will be posted on the ImmunizeCA.org site

42 Thank you for your support and your participation! 42