Is the Shingrix (zoster vaccine) vaccination safe to administer after chemotherapy?

From the Guidelines

Shingrix vaccination is generally safe for individuals who have completed chemotherapy, but timing is crucial, and it's recommended to wait at least 3 months after finishing chemotherapy before receiving the Shingrix vaccine. This recommendation is based on the guidelines provided by the Advisory Committee on Immunization Practices (ACIP) 1. The Shingrix vaccine is a recombinant zoster vaccine, which is preferred for immunocompromised patients, including those recovering from cancer treatment, because it's not a live vaccine and poses no risk of causing infection.

The standard regimen consists of two doses given 2-6 months apart, with each dose containing 50 micrograms of recombinant glycoprotein E antigen and AS01B adjuvant system. Patients should consult their oncologist before vaccination to ensure their immune system has sufficiently recovered 1. The waiting period allows the immune system to rebuild enough to mount an adequate response to the vaccine, as chemotherapy can temporarily suppress immune function.

Some key points to consider:

• Inactivated vaccines, like Shingrix, can be administered during low-dose intermittent or maintenance therapy of immunosuppressive drugs 1.
• Live-attenuated vaccines should not be administered for at least 3 months after immunosuppressive therapy 1.
• Patients vaccinated before chemotherapy for leukemia, lymphoma, other malignancies, or radiation generally are thought to retain immune memory after treatment, although revaccination following chemotherapy for acute lymphoblastic leukemia might be indicated 1.

Side effects of the Shingrix vaccine may include injection site pain, fatigue, and muscle aches, which typically resolve within 2-3 days. Shingrix is particularly important for cancer survivors as they have a higher risk of developing shingles due to their history of immune suppression. It is essential for patients to consult their oncologist before receiving the Shingrix vaccine to determine the optimal timing and ensure their immune system has sufficiently recovered.

From the FDA Drug Label

In the Solid MalignantTumors study (NCT01798056), 117 subjects received SHINGRIX and 115 received placebo. In the PreChemo group, the first dose was administered a maximum of 1 month to a minimum of 10 days before the start of a chemotherapy cycle, and the second dose was administered on the first day of a chemotherapy cycle. In the OnChemo group, each dose was administered on the first day of a chemotherapy cycle.

The Shingrix vaccination can be administered after chemotherapy, but the safety data is limited. Key considerations include:

• The study had a small sample size of 27 subjects in the OnChemo group.
• The safety profile of SHINGRIX was similar to that observed in other studies, but the data is not sufficient to draw a definitive conclusion about the safety of administering SHINGRIX after chemotherapy.
• Caution should be exercised when administering SHINGRIX to individuals who have recently undergone chemotherapy, as the immune system may be compromised. 2

From the Research

Shingrix Vaccination After Chemotherapy

• The Shingrix vaccine, also known as the recombinant zoster vaccine (RZV), is used to protect against herpes zoster infection 3.
• Studies have shown that RZV is safe and effective in immunocompromised individuals, including those undergoing chemotherapy [(3,4)].
• A systematic review and meta-analysis found that RZV reduced the incidence of herpes zoster by 81% in immunocompromised adults 3.
• Another study found that RZV was immunogenic in patients with solid tumors receiving immunosuppressive chemotherapies, with humoral and cell-mediated immune responses persisting 1 year after vaccination 4.

Safety and Reactogenicity

• The Shingrix vaccine has been shown to be safe in immunocompromised individuals, with similar side effects to those in healthy individuals [(3,4)].
• However, one case report found a blistering autoimmune skin reaction following Shingrix vaccination in an ulcerative colitis patient 5.
• Another study found that Shingrix was poorly immunogenic following allogeneic hematopoietic cell transplantation, but this did not increase the risk of varicella zoster virus reactivation 6.

Recommendations

• The Advisory Committee on Immunization Practices recommends immunizing with the recombinant zoster vaccine (RZV) in immunocompromised individuals, including those undergoing chemotherapy 3.
• The vaccine should be administered preferably before chemotherapy or treatment, but it can also be given during chemotherapy [(3,4)].