Seizing Patient Education Opportunities and Recognizing Precautions for Herpes Zoster Vaccination

Pharmacists are now core members of the vaccination community, playing a role in vaccine accessibility, opportunity, identification, and safety. This has become more evident with the unprecedented uptake of the new recombinant, adjuvanted zoster vaccine (RZV, Shingrix). Pharmacists can take advantage of their unique position to promote important aspects of their patient’s health care by exhibiting a proper understanding of when to administer the vaccine to appropriate patients, and, just as important, when not to.

Identifying Opportunities

Patients visit community pharmacies as many as 35 times per year, according to estimates.¹ Although many patients will visit their pharmacist significantly fewer times than this, there is no shortage of opportunities for practitioners to engage in conversations about vaccinations. To be successful, however, pharmacists must be aware of the recommended indications for each vaccine and should form the habit of having these critical conversations with patients.

Vaccinations may occupy the minds of parents during back-to-school season for their children, but adults may not be thinking about protecting themselves. As parents and patients 50 years and older arrive at the pharmacy to ensure their child’s vaccines are up-to-date, pharmacists should ask whether they have considered getting vaccinated for herpes zoster. As with all vaccines, education regarding the disease is critical in the decision-making process for patients.

Multiple Vaccinations

Back-to-school conversations are not the only opportunities to have conversations about vaccines with patients. The fall and early winter bring another critical opportunity: flu season.

Most of pharmacy vaccination volume is related to influenza.² Patients seeking vaccination for influenza already demonstrate a recognition of the importance of immunizations. These patients may be excellent candidates for conversations regarding other vaccines, including RZV, for which they are eligible.

Some adults may be familiar with multiple vaccinations in a single visit for their children. However, multiple vaccinations may be a foreign idea when it comes to their own health. It is safe to receive most adult vaccines during the same visit, and the CDC offers resources to help educate patients about multiple vaccinations. The 1 exception pertains to a patient’s receiving the adjuvanted influenza vaccine (Fluad). Because RZV is also adjuvanted, it cannot be administered at the same time as the adjuvanted influenza vaccine.³

Risks of Delaying Vaccination

When pharmacists are having conversations about immunization, simply handing over information may not be enough. If a vaccine is indicated for a patient, the individual is at some level of risk for contracting the condition, and delaying a vaccination can put an unnecessary risk of infection on the patient.

There has been recent media attention surrounding patients who feel uncomfortable with multiple immunizations, and some patients will spread vaccinations across multiple visits. Because there is no documented benefit to the multiple-visit approach and there is significant risk associated with the practice, proper education can help patients make decisions that are in the best interest of their overall health.

Contraindications and Reasons to Delay RZV

There are, however, some circumstances in which pharmacists should delay administration of RZV, including the following³:

• The patient has an active shingles infection.
• The patient has another active acute infection (signified by a temperature over 101.3°F).
• The patient received zoster vaccine live (ZVL; Zostavax) in the past 8 weeks.
• The patient is pregnant or breast-feeding.

In some situations, RZV may be contraindicated for a patient entirely. Patients known to be seronegative for the varicella zoster virus may be advised against RZV. Despite this contraindication, there is no requirement to screen patients for the varicella zoster virus prior to vaccination. Most adults have been exposed to varicella.

Another reason RZV may be contraindicated is a known hypersensitivity to the vaccine. In this circumstance, the patient may be a good candidate for ZVL. RZV does not have any cross-sensitivity with ZVL. This remains the primary situation in which ZVL would be indicated. ZVL may also be recommended to avoid delaying the vaccination for patients who are unable to access RZV because of a current short supply of the vaccine.

Conclusions

Pharmacists play a critical role in the accessibility of vaccinations. By identifying vaccination opportunities and providing education about vaccines, pharmacists are helping patients avoid significant conditions that could lead to long-term adverse health consequences. Pharmacists must also identify circumstances in which it is unsafe to administer vaccines to certain patients and provide education on any adverse events that may occur after receiving a vaccination. This is particularly important when it comes to RZV, as this vaccine is reputed to have more severe adverse effects than most other routine vaccines.

ERIC ROATH, PHARMD, MBA, is a clinical care coordinator for SpartanNash.

References

• Moose J, Branham A. Pharmacists as influencers of patient adherence. Pharmacy Times®. pharmacytimes.com/publications/directions-in-pharmacy/2014/august2014/pharmacists-as-influencers-of-patient-adherence-. Published August 2014. Accessed July 17, 2018.
• Burson RC, Buttenheim AM, Armstrong A, Feemster KA. Community pharmacies as sites of adult vaccination: a systematic review. Hum Vaccin Immunother. 2016;12(12):3146-3159. doi: 10.1080/21645515.2016.1215393.
• Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for use of herpes zoster vaccines. MMWR Morb Mortal Wkly Rep. 2018;67:103-108. doi: 10.15585/mmwr.mm6703a5.