NAPLEX Question of the Week: Vaccines

One of the most important services pharmacists provide is vaccinating patients to prevent disease. This week's question involves the shingles vaccine.

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A 52 year old male patient presents to his local pharmacy. His past medical history is significant for hypertension, hyperlipidemia, allergic rhinitis, GERD, and psoriatic arthritis. He currently takes lisinopril/hctz 20/12.5mg once daily, atorvastatin 40mg daily, fexofenadine 180mg daily, ranitidine 300mg HS, and etancercept 50mg once weekly. He has NKDA and no other known comorbidities. He asks whether he would be a candidate for Shingrix to prevent shingles (he reports having chickenpox as a child) as he saw an advertisement on TV. How would you respond?

A. He is not a candidate for the Shingrix vaccine.

B. If given Shingrix, he should receive one dose now followed by another dose 12 months later.

C. It should be stored in the refrigerator before usage.

D. Shingrix should be administered at least 4 weeks separately from Pneumovax 23 to maximize immune response.

Answer with rationale:

The correct answer is C. One major difference between Shingrix and Zostavax is storage before administation. Zostavax is a live vaccine that is stored in the freezer while Shingrix is stored in the refrigerator.  Answer D is incorrect as this would be true for Zostavax. In a randomized study, patients who received Zostavax within 4 weeks of Pneumovax 23 had a reduced immune response. Therefore to optimize the Zostavax, consideration should be given to separating the two vaccines by 4 weeks. Answer A is incorrect as he indeed is a good candidate for Shingrix due to being over 50 years of age. He would not be a good candidate for Zostavax due to receiving immunosuppressive therapy for his psoriatic arthritis (etanercept). Answer B is incorrect as the second dose should be given 2-6 months after the first. The national shortage that happened made this difficult in a number of patients over the last year or so but this is optimal.

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.