NAPLEX Question of the Week: Vaccines

Vaccines are an increasingly important part of daily practice for pharmacists, especially in the community setting. Knowing differences in dosing, timing, special populations, and storage is critical when evaluating vaccines.

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YT is a 64 year old female who reports to her local independent pharmacy wishing to receive the Zoster vaccine after talking to her neighbor who recently contracted shingles. Her past medical history is significant for hypertension, hyperlipidemia, and gastroesophageal reflux disease (GERD) for which she takes lisinopril/hctz 20/12.5mg daily, atorvastatin 40mg daily, and omeprazole 20mg daily. She inquires about the newest shingles vaccine called Shingrix. Which of the following is true regarding this vaccine compared to Zostavax? Select all that apply.

A. Shingrix is a live vaccine while Zostavax is an inactivated vaccine.

B. Shingrix requires a 2-dose series while Zostavax requires only one dose

C. Shingrix requires refrigeration while Zostavax must be stored frozen

D. Shingrix's effectiveness wanes significantly over time compared to Zostavax

E. Shingrix administration would be recommended in immunocompetent patients previously vaccinated with Zostavax

Rationale:

Answers B, C, and E are correct. Shingrix does require a two dose series (Answer B) but in turn its effectiveness over time does not wane with age. Therefore Answer D is incorrect as waning over time is known with Zostavax. Storage is an important differentiator between these products (Answer C). In immunocompetent patients who have already received Zostavax, it is still recommended to administer Shingrix (Answer E). Answer A is incorrect as Zostavax is the live vaccine. This is an important differentiator between the two products as Zostavax is contraindicated in immunosuppressed patients while Shingrix is not due to being an inactivated vaccine.

The Advisory Committee on Immunization Practices (ACIP) within the CDC recently updated their overall recommendations for zoster vaccination this year: https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/shingles.html

Christopher M. Bland

Clinical Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.