Can you get the shingles and pneumonia vaccine together

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Can you have pneumonia and shingles vaccine together?
Can shingles vaccine be given with other vaccines?
At what age should you get the shingles and pneumonia vaccine?
Are there any drug interactions with the shingles vaccine?

ImmunizeBC is located on the unceded, ancestral and traditional lands of the xʷməθkʷəy̓əm (Musqueam), Səl̓ílwətaʔ (Tsleil-Waututh), and Skwxwú7mesh (Squamish) Nations. We acknowledge that our work goes beyond the places we live and impacts the lives of nations across British Columbia and Turtle Island. As a step towards reconciliation, this acknowledgement is one part of our commitment to the Calls to Action of the Truth and Reconciliation Commission of Canada.

In 2015, roughly one-third of the elderly population in the U.S. was vaccinated against herpes zoster (HZ), and less than 65% against pneumococcal infection.1 A new study published in Vaccine reports that offering the 23-valent pneumococcal polysaccharide vaccine (PPSV23) and the adjuvant recombinant herpes zoster vaccine (RZV) at the same visit is both safe and equally immunogenic as giving them at separate visits, which may encourage patients to get both of these vaccines.2

Among patients over 50 years old, pneumococcal pneumonia, which can lead to invasive pneumococcal disease, and herpes zoster, which may lead to long-lasting postherpetic neuralgia, are of particular concern.3,4 Therefore, minimizing barriers and changing clinical practice to maximize vaccination rates in this adult population are a priority.

Primary and secondary objectives are identified

In this phase 3, open-label, multicenter study, participants were randomized 1:1 to receive either a co-administered first dose of RZV and PPSV23 at day 0 and the second dose of RZV at month 2 (co-administration or “co-ad” group), or to receive PPSV23 at day 0, the first dose of RZV at month 2, and the second dose of RZV at month 4 (control group). Of note, this study included the newer, recombinant subunit HZ vaccine and not the previous, widely used, live-attenuated HZ vaccine.2

Those eligible for inclusion in the study were adults ³50 years of age who had never received any pneumococcal, varicella zoster virus, or HZ vaccine; who had no history of HZ disease, or pneumococcal disease in the past 5 years; and who had not received immunosuppressants or other immune-modifying drugs for more than 14 consecutive days within the past 6 months. Other exclusion criteria applied.

The primary objectives of the study were to:

measure the vaccine response rate (VRR) to RZV 1 month after the second dose in the co-ad and control groups
compare RZV immunogenicity by measuring the anti-RZV antibody response (anti-gE) following the second RZV dose in the co-ad group versus the control group
compare PPSV23 immunogenicity in the co-ad group versus control group by measuring the opsonophagocytic activity against 12 selected pneumococcal serotypes included in the vaccine (1, 3, 4, 5, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F).

The secondary objective was to evaluate the safety and reactogenicity of RZV and PPSV23 when co-administered versus when administered sequentially.

Safety and immunogenicity remain intact

A total of 865 adults (432 co-ad, 433 controls) were vaccinated. Of these, 829 (412 co-ad, 417 controls) were included in the immunogenicity studies, and 842 (423 co-ad, 419 controls) were included in the safety studies. Demographics were comparable between groups.

VRR to RZV was defined as the percentage of participants with a fourfold increase in anti-gE antibody concentration from baseline (or from the seropositivity cutoff, if negative at baseline), assessed using blood samples collected at month 0 and 1 month after the second vaccination. Response rates were 98.3% in both the co-ad and control groups, demonstrating non-interference between RZV and PPSV23 with regards to RZV response rate.

One month following the second vaccination with RZV, humoral antibody responses against RZV in the co-ad group were not inferior to those in the control group. The anti-gE geometric mean concentration (GMC)control/GMCco-ad ratioadjusted at 1 month after the second dose of RZV was 1.02 (95% confidence interval [CI] 0.93 to 1.11]. Thus, co-administration of RZV and PPSV23 did not weaken the humoral immune response to RZV, relative to sequential administration of the 2 vaccines.

What about adverse effects?

With regards to reactogenicity, local symptoms were reported by 84.1% of participants (grade 3, 12.6%) when RZV and PPSV23 were co-administered, 73.0% (grade 3, 7.6%) when the first dose of RZV was given alone, and 41.3% (grade 3, 1.6%) when PPSV23 was given alone. However, overall, solicited adverse events (AEs) were reported by similar percentages of participants in the 2 study groups, and within 30 days after vaccination unsolicited AEs were reported at similar rates (30.6% co-ad versus 32.3% controls). Investigator-determined, vaccine-related, unsolicited AEs were 7.9% in the co-ad group and 6.5% in the control group. No new safety concerns were raised.

“No immunologic interference was observed between RZV and PPSV23 when co-administered in adults ³50 years, and no safety concerns were raised,” the study authors concluded. “These results support the concomitant administration of RZV and PPSV23 at the same clinic visit, which might increase the opportunities of older adults for vaccination against HZ and pneumococcal disease.”2

While this study measured humoral immune responses to co-administered vaccines and determined that immunogenicity wasn’t affected, it will be important to determine whether true vaccine efficacy is maintained, by determining the long-term infection rates of patients who receive co-administered versus sequential vaccinations. Similarly, the vast majority of participants in this study were Caucasian, meaning this work will need to be verified in a more diverse patient population.

Published: August 24, 2018

Can you have pneumonia and shingles vaccine together?

Pneumonia and shingles vaccines cannot be given together although either of them can be given with the flu vaccine. So, if you require all three vaccines you will need two separate appointments.

Can shingles vaccine be given with other vaccines?

Q: Can I give Shingrix with other adult vaccines? A: Yes, Shingrix is an inactive vaccine so you can administer it with other inactive or live vaccines.

At what age should you get the shingles and pneumonia vaccine?

The shingles vaccine is approved for adults age 50 and older and for those 18 and older whose immune systems are weakened or who will be at increased risk of herpes zoster because of a disease or treatment, notes the CDC.

Are there any drug interactions with the shingles vaccine?

Some products that may interact with this vaccine are: drugs that weaken the immune system (including cyclosporine, tacrolimus, cancer chemotherapy, corticosteroids such as prednisone).