Many of us are aware that recombinant zoster vaccine (RZV, Shingrix) has been in short supply for several months.  Unfortunately, the shortage is expected to continue for the remainder of 2018 and throughout all of 2019.

Demand for RZV is soaring.  Because the recombinant vaccine is indicated for ages 50 and above (compared to 65 and older for the live zoster vaccine) and requires a two-dose series (compared to single dose for the live vaccine), there are simply millions more doses to be given.  The 90% efficacy rate (vs. 75% for the live vaccine) is driving more patients to opt in favor of vaccination as well. 

GlaxoSmithKline, maker of RZV, has been unable to keep up with this enormous demand.  The vaccine is currently offered by 9800 pharmacies and 1100 clinics.  It  takes 6 to 9 months to produce the vaccine, and while large amounts are shipped to wholesalers every 2 to 3 weeks, with bimonthly shipping to begin this month, demand continues to overwhelm the supply chain.  Wait lists are long, and doses are often spoken for before they leave the supplier.

Out of necessity, patients are often advised to shop around for pharmacies and clinics with vaccine in stock, but all parties must be aware that significant problems may arise from this practice. Several cases have been reported whereby patients who were waitlisted for a first or second dose of RZV were contacted by the pharmacy or clinic when supply was received.  Doses were subsequently administered, only to learn after the fact that the patient had already received a dose from another site.  Careful immunization histories and consultation of the Wisconsin Immunization Registry by providers and pharmacists are critical prior to administering all doses of shingles vaccine in order to prevent unnecessary cost (up to $175 per dose), unnecessary side effect burden, and ultimately, exacerbation of the shortage.

Providers looking to prioritize immunization are encouraged to consider giving higher priority to patients aged 70 and older as well as bone marrow transplant recipients, as these groups represent those at greatest risk for serious consequences from zoster reactivation.

GlaxoSmithKline recommends that the second RZV dose be given 2-6 months after the first.  However, patients and providers should be aware that this is a recommendation, not a requirement.  As with any vaccine series, intervals may exceed the recommended window; they just cannot be given closer together than the minimum interval.

References:

Continuing Shingrix Vaccine Shortage Challenging Physicians, Patients.  Medscape. Nov 21, 2018.  Accessed at www.medscape.com/View article/905419 on November 30, 2018.

Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Morb Mortal Wkly Rep 2018;67:103–108. DOI: http://dx.doi.org/10.15585/mmwr.mm6703a5