November 20, 2017
New Vaccine and Recommendations for Shingles: Shingrix is an inactivated recombinant vaccine licensed in the U.S. in October 2017. The vaccine has at least 90% efficacy in preventing shingles and is highly effective in preventing postherpetic neuralgia. It is recommended for healthy adults ages 50 years and older. Based on high efficacy rates, it is recommended over the previous live-attenuated vaccine Zostavax and is also recommended for adults who previously received Zostavax. Shingrix is given intramuscularly in two doses; the second dose is given 2 to 6 months after the first dose.
CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK
Live vaccines may confer life-long immunity but cannot be administered to immunosuppressed patients.
Inactivated and subunit vaccines and toxoids often require multiple doses to protect from infection, and generally booster doses are needed following the primary series.
Children less than 2 years of age are unable to mount T-cell–independent immune responses that are elicited by polysaccharide vaccines.
Severely immunocompromised individuals should not receive live vaccines, and their responses to inactivated, polysaccharide, toxoid, and recombinant vaccines may be poor.
The childhood and adult immunization schedules are updated frequently and published annually. These documents can be used to develop an immunization plan.
Immunoglobulin (Ig) provides short term, rapid postexposure protection from measles, hepatitis A, varicella, and other infections.
Ig adverse effects are often secondary to infusion rate. Slowing the IV infusion rate ameliorate chills, nausea, and fever that may develop during administration.
Rho(D) Ig prevents Rh-negative mothers from mounting an immune response against hemolytic disease of the newborn. Hemolytic disease of the newborn results when Rh-negative mothers are sensitized to the Rh(D) antigen on the red blood cells of their fetuses.
Immunization is defined as rendering a person protected from an infectious agent. Immunity to an infectious agent can be acquired by exposure to the disease, by transfer of antibodies from mother to fetus, through administration of immunoglobulin (Ig), and from vaccination. Immunization is the process of introducing an antigen into the body to induce protection against the infectious agent without causing disease. An antigen is a substance that induces an immune response. An antibody produced by the humoral arm of the immune system usually is the response that is measured as evidence of successful vaccination. However, cellular immune responses, which are more difficult to measure, are also an important aspect of vaccine responses.
This chapter introduces the clinical use of vaccines and immunoglobulins. Agents with a limited use, such as agents for bioterrorism or travel, are beyond the scope of this chapter.
PRODUCTS USED TO IMMUNIZE
Vaccines induce active immunity—that is, immunity generated ...