Wednesday House Call,   March 21, 2018: New shingles vaccine guidelines

Wednesday House Call,   March 21, 2018

Dr Barry Dworkin joins Rob Snow to discuss the latest health stories of the week.

We talk about new guidelines for shingles prevention and the new vaccine that has just been approved for use in Canada.

Vaccination to prevent herpes zoster

For most patients who meet criteria for zoster vaccination, we suggest the recombinant zoster vaccine (RZV) rather than the live attenuated zoster vaccine (ZVL) (Grade 2B). For patients who previously received ZVL, we suggest revaccination with RZV (Grade 2C).

Two vaccines are available to prevent herpes zoster and postherpetic neuralgia in patients ≥50 years of age: a recombinant glycoprotein E vaccine (recombinant zoster vaccine [RZV], approved for use in the United States in October 2017) and a live attenuated vaccine (zoster vaccine live [ZVL]). We suggest RZV rather than ZVL for most patients who meet criteria for vaccination. RZV appears to provide greater protection against herpes zoster, and there is less concern for waning immunity. The choice of RZV as the preferred type of vaccine is consistent with recommendations from the Advisory Committee on Immunization Practices [3]. Disadvantages of RZV are the need for two doses (versus one with ZVL), and an increased risk of mild to moderate side effects (pain at the injection site, myalgia, fatigue, headache, fever) that typically resolve in one to three days. These factors rarely prevent patients from completing the RZV series. For patients who previously received ZVL, we suggest revaccination with RZV. The optimal use of RZV in immunocompromised patients is still to be determined.

Your calls:

  • Knee pain and joint replacements
  • Lump in the chest
  • Blood hemoglobin levels. What is normal?
  • A man with history of two MIs has stopped his meds and wants to know if atenolol is a good medication to use. That and much more.
  • Nipple discharge in a 22 year-old man
  • Should you get the new shingles vaccine of you have previously had the live vaccine?
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