Shingles Vaccine: What Ontario Seniors Need to Know About Shingrix®

What is new with the Ontario publicly funded shingles (herpes zoster) program?

Starting mid-October 2020, the Ontario publicly funded shingles immunization program, available for seniors ages 65 to 70 years, will begin to transition from offering the Zostavax®II (Merck Canada Inc.) vaccine to the Shingrix® (GSK) vaccine. Shingrix® is a recombinant, adjuvanted subunit vaccine that was authorized for use in Canada in October 2017 as a two-dose series for individuals 50 years of age and older for the prevention of herpes zoster (HZ). The vaccine is supplied as a vial of lyophilized recombinant varicella zoster virus surface glycoprotein E (VZV gE) which is reconstituted at the time of use with the accompanying vial of adjuvant suspension. Shingrix® is administered intramuscularly as a two-dose schedule 2 to 6 months apart.

Why is Ontario changing to the Shingrix® vaccine?

Current evidence and expert recommendations from the National Advisory Committee on Immunization (NACI) indicate that Shingrix® is more effective for preventing HZ infection and related complications.

How does Shingrix® compare to Zostavax® II?

Shingrix® has been shown to be safe and effective for the prevention of HZ and its most common complication, post-herpetic neuralgia (PHN). Based on clinical studies, the incidence of HZ and PHN, as well as the duration and severity of HZ were significantly reduced in Shingrix® vaccine recipients. Overall vaccine efficacy was above 90% for HZ incidence and 88–91% for the prevention of PHN and slower waning immunity.

Are booster doses of Shingrix® recommended?

The need for a booster dose following the primary two-dose vaccine series has not been established. Available studies have demonstrated a longer duration of protection against HZ from Shingrix® with immunogenicity being demonstrated up to nine years post-immunization. Minimal waning in vaccine efficacy was seen after four years following vaccination with Shingrix® remaining at 90 percent or more protection for all four years.

What are the eligibility criteria for the Shingrix® vaccine?

Since September 2016, Ontario has offered seniors 65 to 70 years the opportunity to receive a one-time publicly funded dose of HZ (Zostavax® II) vaccine through the publicly funded immunization program. Starting mid-October, Ontario seniors age 65 to 70 years (i.e., from the 65th birthday to the day prior to the 71st birthday) are eligible for the 2-dose publicly funded Shingrix® series, provided they have not received the Zostavax® II vaccine through the Ontario publicly funded shingles immunization program. The series needs to be completed before the 71st birthday. Seniors outside the eligibility criteria can speak with their primary care providers about purchasing the vaccine privately.

Please Note: As a result of COVID-19, individuals born in 1949 or 1950 (i.e., 70-year olds turning 71 in 2020 or 2021 calendar year) who have missed the opportunity to receive the publicly funded Zostavax® II are eligible to receive Shingrix® and complete the 2-dose series by December 31, 2021.

How will eligible individuals access publicly funded Shingrix®?

Individuals aged 65 to 70 will be able to receive the Shingrix® vaccine through their primary health care provider. Primary health care providers are encouraged to identify and offer the Shingrix® vaccine to their eligible patients.

What if seniors previously received the publicly funded Zostavax®II vaccine?

Seniors aged 65 to 70 years who received the publicly funded Zostavax® II are not eligible for the publicly funded Shingrix® vaccine series. Seniors interested in privately purchasing Shingrix® should speak to their health care provider.

What if seniors previously paid for Zostavax® II vaccine?

Seniors aged 65 to 70 years who previously paid for Zostavax® II vaccine are eligible to receive the publicly funded Shingrix® vaccine. Primary care providers should discuss the risks and benefits of re-immunization with Shingrix® vaccine according to NACI recommendations and expert opinion.

What if an individual does not have a previous history of chickenpox?

Yes, Shingrix® vaccine should be administered to individuals eligible for the vaccine regardless of whether or not the person has a history of varicella infection. Nearly all Canadians eligible for shingles immunization will have had prior varicella exposure, even if a diagnosis of varicella cannot be recalled.

Please note: At this time there is insufficient evidence to assess the risk related to herpes zoster ophthalmicus recurrence following Shingrix® vaccination.

Can Shingrix® be given simultaneously with other vaccines?

Shingrix® may be administered concomitantly with, or at any time before or after, other inactivated vaccines or live vaccines using different injection sites and separate needles and syringes. Shingrix® may be given at the same time as unadjuvanted seasonal influenza vaccine. Studies of co-administration with adjuvanted seasonal influenza vaccine (Fluad®) have not been conducted. Review the product monograph for further information on concomitant administration of Shingrix® and the annual influenza vaccine.

Can the vaccine be given to individuals when they are ill?

Those with a severe acute illness with or without fever should usually wait until the symptoms subside before being immunized. During the COVID-19 pandemic, individuals with symptoms of acute respiratory infection, including minor symptoms such as sore throat or runny nose, should defer immunization until they have recovered, as they can pose an unnecessary risk to others and health care providers if they have COVID-19. Further information on general advice on administering vaccine during COVID-19 precaution can be found in the Guidance for Immunization Service During COVID-19. See also: COVID-19 Vaccination.

Who should not receive Shingrix®?

Shingrix® should not be given to individuals who have had an anaphylactic hypersensitivity reaction to past doses of the vaccine, or allergies to any component of the Shingrix® vaccine. Further information on who should not receive the Shingrix® vaccine can be found in the product monograph.