Reactivation of the chicken-zona virus, the zona is a painful dermatosis that generally affects adults. The local lesion, most often at the level of the thorax, the head, the cervical, the lumbar, the sacrum or the eyes, persists 2 to 3 weeks then generally heals without sequelae in immunocompetent subjects. Complications can nevertheless occur, in particular post-Zosterian pain in the territory concerned, but also bacterial infections, neurological manifestations, meningitis and encephalitis. These more often affect patients over 50 (1/4 of over 75s develop post-zosterian pain) and can be particularly deleterious in immunocompromised and/or polymedic people.
The Recombinant Shingrix vaccine, which replaced the Zostavax living vaccine in vaccination recommendations, has been supported by health insurance since December 2024.
Which patients are concerned?
Previously recommended in adults aged 65 to 74, zona vaccination follows a strategy updated by HAS in 2024, in particular linked to the provision of the Shingrix vaccine. It is now recommended for the prevention of zona and the risk of post-zoster pain in:
- Immunocompetent adults aged 65 and over
- Immunode -depressed people from 18 years old, whatever the origin of the immune deficit: primitive, acquired, immunosuppressive treatment …
The vaccine recommendations specify that in the event of breastfeeding, vaccination by Shingrix should be evaluated on a case -by -case basis within the framework of a shared medical decision. In the absence of data, the AMM mentions that it is better not to use Shingrix in pregnant women.
The vaccine is recommended as upstream as possible of immunosuppressive therapy and so that the vaccination scheme is ideally complete 14 days before the initiation of treatment.
How to vaccinate?
Shingrix, the only vaccine now available, is a recombinant vaccine, hence its possible use in the event of immunosuppression. It is formulated from a surface antigen of the Micken-Zona virus, glycoprotein E, and an adjuvant. Presented in bottles, powder and solvent, it can be kept in the refrigerator between 2 and 8 ° C and must be reconstituted before administration.
The way of administration. Intramuscular only, preferably in the deltoid muscle.
The vaccination scheme. Identical in immunocompetent or immunocompromised adults: 2 doses spaced 2 months. The delay between the two doses can be increased with flexibility between 2 and 6 months for the second dose, for example to postpone vaccination in the event of a severe febrile episode in progress. It can be reduced to one month if there is a rapid immunization, especially before initiation of immunosuppressive therapy. The need for doses of reminders has not been established to date.
Note : If the delay between the two doses exceeds 6 months, it is not necessary to start the vaccination scheme back at the start.
Vaccinate on pharmacies
The Shingrix vaccine can be prescribed and administered to the pharmacy, including for immunocompromised people.
Management. It is now 65 % supported for people targeted by recommendations.
Co-administrations. Shingrix can be administered at the same time, but in different sites, as an inactivated vaccine against flu, a 23-valent or valent pneumococcal vaccine, a reduced dose vaccine in diphtheria, tetanical and acellular diphents (DTCA), an arnm vaccine against COVVI-19.
Should we vaccinate with Shingrix if …
- The person has a history of Zona?
Yes, the history of Zona do not protect a recurrence. The vaccination scheme is identical, 2 doses 2 months apart, ensuring at least 1 year between the episode of Zona and the administration of the first dose of the vaccine.
- Has the person already been vaccinated with Zostavax?
Yes, the objective is to acquire better protection against the zona and its complications. Immunogenicity data show that the immune response is better with Shingrix (protection is evaluated at more than 79 % against 46 % for the living vaccine).
The two -doses scheme applies with the same precautions as in the event of Zona’s history: at least 1 year between vaccination with Zostavax and the first dose of Shingrix.
