2022 CDC, ACIP Updates to Patient Eligibility for Shingles Vaccination

Unlike the 2022 simplification updates for the hepatitis B and pneumococcal vaccine recommendations, ACIP’s recommendations for patient eligibility for zoster vaccination have become more complicated this year.

Today, many patients 50 years of age and over are healthier and more active than previous generations, explained Amanda Price, PharmD, BCACP, in a presentation at the American Society of Health-System Pharmacists 2022 Summer Meeting. Because of this, vaccinating this population against shingles is far more valuable than it was for previous generations.

“I had somebody tell me the other day, ‘50 is the new 20.’ I thought, ‘Oh, I don’t want to live through my 20s again. That wasn’t fun,’” Price said. “I recognize though that many patients who are 50 are young, healthy, and active. So if we can help this population avoid the morbidity associated with shingles infection—that’s a good thing.”

Unlike the 2022 simplification updates from the CDC and Advisory Committee on Immunization Practices (ACIP) for the hepatitis B and pneumococcal vaccine recommendations, Price explained that ACIP’s recommendations for patient eligibility for zoster vaccination have become more complicated this year.

“Last year, it was fairly straightforward. All adults aged 50 or older were eligible for a shingles vaccine. And to be honest, in patients who are immunocompetent over the age of 50, shingles can cause some significant morbidity, but it’s not likely to lead to serious complications in health care,” Price said.

In contrast, immunocompromised patients are much more likely to experience complications from zoster infection, potentially requiring hospitalization and more significant morbidity and even mortality. Because of this, the ACIP identified that immunocompromised patients should be offered protection from zoster infection and subsequently updated their recommendations for vaccination eligibility in 2022. Now, the ACIP specifies that all adults aged 50 years and older and all immunocompromised adults aged 19 to 49 years are eligible for zoster vaccination.

Additionally, Price explained that an important point of clarification for immunizers regarding zoster eligibility is around whether a patient who has had a zoster infection can be given the vaccine. Price noted that as long as the acutely infectious phase of the zoster infection is resolved, it’s safe to give the zoster vaccination.

Additionally, Price explained that although it’s uncommon for immunocompetent patients to experience a second round of shingles infection, it is common for this to occur in the immunocompromised patient population.

“So getting an immunocompromised patient immunized after initial infection is a great idea to help reduce that morbidity,” Price said. “If you can, it’s great to get them immunized prior to immunosuppression as well.”

Additionally, for patients who have been treated with immunosuppressive agents, it can be beneficial to consider revaccination with the zoster vaccine 3 months after the immunosuppressive therapy. Specifically, Price noted this would be advantageous to consider for patients with cancer following chemotherapy treatment, although that interval increases to 6 months after treatment with rituximab (Rituxan; Genentech USA).

Furthermore, Price explained that something new worth noting is that patients are not at risk for shingles if they have not had exposure to the varicella virus, either through native infection or from the vaccine.

“Obviously the risk is much higher with a native infection, but it is still present with the vaccine,” Price said.

However, ACIP and CDC recommends that for immunocompetent adults, it’s not necessary to identify their varicella status. On the other hand, in immunocompromised patients, they clarify that varicella status must be assessed before vaccination against zoster, with proof of some form required, as the CDC does not accept patients reporting their own status in this case.

REFERENCE

Price A. Vaccination Updates 2022: COVID-19 and Beyond. Presented at: ASHP Summer Meeting 2022; June 12, 2022; Phoenix, AZ.