Shingrix Shingles Vaccine Description
GSK's Shingrix is an adjuvanted recombinant zoster vaccine, consisting of the varicella-zoster virus glycoprotein E antigen and the AS01B adjuvant system, a proprietary adjuvant containing QS-21 and MPL with liposomes.
Shingrix is the only shingles vaccine proven to be up to 90% effective in various clinical trials, says GSK. Shingles, also known as herpes zoster, is a painful skin rash caused by reactivation of the varicella-zoster virus, which causes chickenpox.
Shingrix works to boost your body’s protection against shingles. Your immune system declines as you age, and that puts you at an increased risk for shingles. For those who are 50 years and older, Shingrix helps your immune system defend against shingles regardless of age.
Recombinant zoster vaccine (RZV, Shingrix) has been used since 2017, says the U.S. CDC. On October 20, 2017, the U.S. FDA issued its authorization.
London, England-based GlaxoSmithKline (GSK) is the producer of Shingrix, which produced about $2.2 billion in revenues during 2019. The global shingles vaccine market is poised to grow by USD 1.08 billion during 2020-2024, progressing at a CAGR of over 7% during the forecast period.
GSK’s top priority is patient safety. "We are committed to monitoring and ensuring the safety of all our products, including SHINGRIX (Recombinant Zoster Vaccine/RZV)."
Shingrix Shingles Vaccine Indication
Shingrix is a vaccine for preventing shingles (herpes zoster) in adults 50 years and older. If you’re one of the 99% of adults over 50 years old, who have had chickenpox, the virus that causes shingles is inside your body and can reactivate at any time. 1 in every 3 people in the US will get shingles in their lifetime, says GSK.
People should not receive Shingrix if they are allergic to any of its ingredients or had an allergic reaction to a previous dose of Shingrix. And, Shingrix was not studied in pregnant or nursing women. Tell your healthcare provider if you are pregnant, plan to become pregnant, or are breastfeeding, says GSK.
Shingrix is not used to prevent primary varicella infection (chickenpox).
Shingles is a painful rash that develops on the face or body. The rash consists of blisters that typically scab over in 7 to 10 days and fully clear up within 2 to 4 weeks. Before the rash appears, people often have pain, itching, or tingling in the area where it will develop. This may happen several days before the rash appears.
The rash occurs in a single stripe around either the left or the right side of the body. In other cases, the rash occurs on one side of the face. Shingles on the face can affect the eye and cause vision loss. In rare cases (usually in people with weakened immune systems), the rash may be more widespread on the body and look similar to a chickenpox rash.
Complications can arise with Shingles, especially in older adults. However, the National Insitute on Aging says 'the shingles vaccine is safe and easy, and it may keep you from getting shingles and ongoing pain called post-herpetic neuralgia, or PHN. Healthy adults age 50 and older should get vaccinated with a shingles vaccine called Shingrix.'
The most common shingles complication is long-term nerve pain called postherpetic neuralgia (PHN). PHN occurs in the areas where the shingles rash was, even after the rash clears up. It can last for months or years after the rash goes away. The pain from PHN can be so severe and debilitating that it interferes with daily life.
About 10 to 18% of people who get shingles will experience PHN. Your risk of PHN increases with age. An older adult with shingles is more likely to develop PHN and have longer-lasting and more severe pain than a younger person with shingles. People younger than 40 rarely experience PHN.
A study published on May 15, 2020, in ACR Open Rheumatology showed that the vaccine did not prompt flares of rheumatoid conditions.
Shingrix Shingles Vaccine Dosage
Shingrix is a suspension for intramuscular injection only. It is supplied in 2 vials (0.5 mL each) that must be combined before administration. Two doses are necessary to provide strong protection, up to 90%, the first dose at Month 0, followed by a second dose administered anytime between 2 and 6 months later.
The Shingrix vaccine series is administered as an injection into the upper arm's muscle. It is important to complete the 2‑dose series to help prevent shingles. The CDC has stated: If more than 6 months have elapsed since the 1st Shingrix dose, administer the 2nd dose as soon as possible. Do not restart the Shingrix vaccine series.
Shingrix Shingles Vaccine Warning
The U.S. FDA Safety Communication issued a notice on March 24, 2021, to inform the public and healthcare providers that FDA has required and approved safety labeling changes to the Prescribing Information for Shingrix (Zoster Vaccine Recombinant, Adjuvanted) based on post-marketing experience. The revised label includes Guillain-Barré Syndrome (GBS) in the "Warnings and precautions" section.
On February 25, 2021, meeting of the US Centers for Disease Control and Prevention Advisory Committee on Immunization Practices, the Herpes Zoster Work Group presented results of a comprehensive risk-benefit analysis of SHINGRIX that included a review of post-marketing data. The analysis concluded: GBS is rare, and data on the risk of GBS following HZ (herpes zoster or “shingles”) and vaccination are limited. Clinical trials, observational studies, and the risk-benefit analysis confirm the considerable benefits of RZV (SHINGRIX) vaccination in preventing HZ, severe disease, and complications.
'GSK remains confident in the favorable benefit-risk profile of SHINGRIX for the prevention of shingles. We will continue to communicate with FDA and CDC on post-marketing safety monitoring for SHINGRIX.'
Shingrix Shingles Vaccine Billing Codes
SHINGRIX has broad insurance coverage for patients. The CPT Code (Product): 90750. Additional codes are found at this GSK link.
The GSK Vaccines Reimbursement Support Center is a resource for physicians, physician office staff, and pharmacists to address questions about billing, coding, and reimbursement for GSK vaccines.
Shingrix Shingles Vaccine News
April 28, 2021 - GSK reported quarterly sales of Shinrix decreased about 47%.
March 30, 2021 - The FDA required GlaxoSmithKline, the manufacturer of Shingrix, to revise the Prescribing Information to include the following language in the Warnings and Precautions section: In a post-marketing observational study, an increased risk of Guillain-Barré syndrome was observed during the 42 days following vaccination with Shingrix.
February 25, 2021 - U.S. CDC ACIP Meeting presentation: Summary of the Herpes Zoster Work Group’s Interpretation of Recombinant Zoster Vaccine Safety Data.
February 9, 2021 - WebMD reported searches for the term “covid shingles” were recently searched. "There is no scientific evidence of this [association]," says Aaron Glatt, MD, chief of infectious diseases at Mount Sinai South Nassau in Oceanside, NY, and a spokesperson for the Infectious Diseases Society of America.
February 4, 2021 - GlaxoSmithKline plc reported fourth-quarter 2020 sales from the Vaccines segment were up 16% at CER, driven by the strong recovery in demand for Shingrix: sales rose 23% in the reported quarter, driven by strong demand in Europe.
January 13, 2021 - The UK's Public Health England update stated: People aged 70 years of age are eligible for the vaccine. By having the vaccination, you will significantly reduce your chance of developing shingles. In fact, in the first 3 years since the vaccine was introduced, there were about 17,000 fewer GP consultations for shingles. And, if you do go on to have shingles, the symptoms are likely to be milder and the illness shorter than if you had not had the vaccination. Like all licensed vaccines, the shingles vaccine has been thoroughly tested and meets the UK and European safety and licensing requirements. It has been used extensively in several countries, including the United States of America and Canada. In the first 4 years of the shingles vaccination program, more than 2.3 million people were vaccinated in England.
December 14, 2020 - The majority of Medicare beneficiaries who received an initial dose of the Shingrix vaccine received the second dose within six months. Still, follow-up rates were lower among beneficiaries in communities of color, those who are younger than age 65 with long-term disabilities, and low-income beneficiaries. Most (74%) Medicare beneficiaries who received an initial dose of Shingrix between January and June of 2018 received the second dose within 6 months. Conversely, 1 in 4 beneficiaries (26%) who received an initial dose of Shingrix between January and June 2018 did not receive the second dose within the recommended timeframe. An additional 6% of beneficiaries received the second dose after the 6-month timeframe but no later than the end of 2018. This analysis is based on 2018 Medicare Part D prescription drug event claims data from a 20% sample of Medicare beneficiaries from the Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse. Our analysis includes 0.8 million Part D enrollees who were enrolled for the full 2018 calendar year and who received an initial shot of Shingrix between January and June of 2018.
January 4, 2021 - The U.S. CDC updated its Shingrix frequently asked questions webpage for health care providers with guidance on shingles vaccination during the COVID-19 pandemic. Shingles vaccination is an essential preventive care service for older adults that should not be delayed or discontinued because of the COVID-19 pandemic unless a patient is suspected or confirmed to have COVID-19.
November 23, 2020 - Updated study: Recombinant Zoster Vaccine Is Efficacious and Safe in Frail Individuals. The relatively nonrestrictive inclusion/exclusion criteria in the parent ZOE studies resulted in a range of participants that included frail and pre‐frail older adults. RZV significantly reduced the risk of herpes zoster across all frailty subgroups.
October 9, 2020 - The new GSK campaign for its shingles vaccine coalesced their message around a straightforward statement: “Shingles Doesn’t Care.” They tell consumers that you can do everything right health-wise and still get shingles.
October 8, 2020 - Shingles vaccine: Should I get it? People looking to receive the shingles vaccine now have two options. The Food and Drug Administration in 2017 approved Shingrix. It's the preferred alternative to Zostavax, which was approved in 2006.
September 30, 2020 - The Government of Yukon is publicly funding a shingles vaccine for Yukoners between the ages of 65 and 70, the age at which the vaccine is most effective. The shingles vaccine, Shingrix, will be publicly funded in Yukon beginning January 1, 2021.
August 5, 2020 - GSK launched a national campaign to help increase low rates of vaccination among older adults. The campaign, Brought to You By Vaccines, will educate adults ages 50 and older about vaccines' value and the urgent need to talk to their healthcare provider or pharmacist about the recommended vaccines they need or may have recently missed. Since the declaration of the COVID-19 pandemic and public health measures to slow the spread of the disease in the US, ordering rates across adult vaccines among healthcare practices have dropped an average of 62 percent.
July 9, 2020 - The number of senior Americans who report receiving a shingles vaccination had risen steadily since 2008, new data from the US Centers for Disease Control and Prevention's (CDC's) National Center for Health Statistics revealed. The proportion of people in this age group (60+) who were vaccinated rose from 6.7 percent in 2008 to 34.5 percent in 2018, reported the CDC.
June 9, 2020 - The U.S. CDC says, 'The COVID-19 pandemic has caused healthcare providers to change how they operate to continue to provide essential services to patients. Ensuring immunization services are maintained or reinitiated is essential for protecting individuals and communities from vaccine-preventable diseases.'
July 3, 2020 - The Science and Technology Daily reported the vaccine, Shingrix, was developed by British pharmaceutical giant GlaxoSmithKline. China's National Medical Products Administration approved it for the market in May. It is on a list of 48 "clinically urgently needed new drugs" for fast-track approval by the administration and is currently the only recombinant shingles vaccine on China's market.
June 2020 - Harvard Health: Shingles vaccine may also reduce stroke risk.
May 15, 2020 - Safety of the Zoster Vaccine Recombinant Adjuvanted in Rheumatoid Arthritis and Other Systemic Rheumatic Disease Patients.
April 29, 2020 - GSK announced Shingrix sales grew 81% AER, 79% CER to £647 million, primarily driven by continued strong uptake in the US. Germany and Canada also contributed to growth.
April 26, 2020 - Shingrix induces persistent immune responses in older adults, regardless of a Zostavax vaccine dose.
April 16, 2020 - The National Advisory Committee on Immunization has recommended LZV as a standard vaccine for HZ prevention in adults ≥ 50 years of age, but no studies directly comparing the safety and efficacy of RZV and LZV vaccines have been conducted. This article reviews the brief history, efficacy, and safety of the two vaccines and discusses the advantage of RZV over LZV based on the available literature.
March 2, 2020 - Shringrix was no longer listed on the CDC's vaccine shortage list.
February 27, 2020 - The Adjuvanted Recombinant Zoster Vaccine in Adults Aged ≥65 Years Previously Vaccinated With a Live-Attenuated Herpes Zoster Vaccine.
February 2020 - Aggregate health and economic burden of herpes zoster in the United States.
November 29, 2019 - This study suggests that exogenous boosting provides some protection from the risk of herpes zoster but not complete immunity, as assumed by previous cost-effectiveness estimates of varicella immunization.
October 23, 2019 - Long-term Immunological Persistence of the Adjuvanted Recombinant Zoster Vaccine: Clinical Data and Mathematical Modeling.
May 22, 2019 - China’s National Medical Product Administration (NMPA) announced the ‘conditional approval’ for Shingrix.
August 16, 2019 - The new shingles vaccine's availability is improving across the Military Health System. The vaccine, Shingrix, is recommended for healthy adults 50 and older to prevent the painful skin rash that can have debilitating long-term effects for older people. "But availability to the Department of Defense has improved from a year ago and continues to get better," he said, adding that beneficiaries should contact their local MTF to confirm supplies. "Now is the time to get your shingles immunization."
July 9, 2019 - GSK Herpes Zoster Vaccine Shingrix reduced the incidence of herpes zoster in autologous stem cell transplant recipients. Among adults who had undergone autologous HSCT, a 2-dose course of recombinant zoster vaccine compared with placebo significantly reduced the incidence of herpes zoster over a median follow-up of 21 months.
September 22, 2018 - The Journal of Infectious Diseases, Volume 218.
January 26, 2018 - Recommendations of the CDC's Advisory Committee on Immunization Practices for the Use of Herpes Zoster Vaccines.
Shingrix Shingles Vaccine Clinical Trials
Since October 20, 2017, the US FDA approved zoster vaccine recombinant, adjuvanted (Shingrix, GlaxoSmithKline Biologicals) for the prevention of herpes zoster in adults aged ≥50 years.