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Infectious Diseases Specialist
Fountain Valley Hospital
Fountain Valley, California
Dalilah Restrepo, MD, has no relevant conflicts of interest to report.
Implementing a shingles vaccine protocol in a busy outpatient practice is hard normally, but it is overwhelming during a respiratory virus pandemic. Here are my thoughts on how to handle this during the era of COVID-19.
The usual difficulties associated with vaccine cost, storage capacity, and reimbursement before the COVID-19 pandemic seem almost trivial now, when challenges include avoiding exposure to a deadly virus in a healthcare professional’s office, timing the life-saving COVID-19 vaccine without competing with any other vaccine, and counseling about adverse events in an already vaccine-hesitant environment. However, here we are—and advocating for our patients’ well-being remains our top priority. Evidence suggests that the COVID-19 pandemic has resulted in many adults being undervaccinated, which places our communities at risk for vaccine-preventable diseases. It also is clear that nationally, our health systems are strained beyond capacity, and we must do everything we can in the prevention arena to avoid further demand.
Vaccination is the only method for preventing herpes zoster reactivation and its complications. The recombinant zoster vaccine (RZV) is safe and should be encouraged despite the ongoing pandemic, especially because people at risk for severe COVID-19 may require immunosuppressants (eg, corticosteroids) as part of their COVID-19 treatment regimen.
There is no contraindication to administering a shingles vaccine in people recovered from COVID-19, as long as they are not infectious. Considering the risk of exposure to others at the vaccination center, it is important to remind patients to wait until they’ve completed their COVID-19 isolation period before visiting any vaccine center, pharmacy, or outpatient setting.
Counseling about potential RZV adverse events is particularly important now, as these can mimic symptoms of acute COVID-19 illness, which can cause anxiety for the patient and can be a diagnostic challenge for the healthcare professional or public health authority triaging risk.
We should use the resources highlighted by the pandemic to improve the rollout of other vaccines and welcome the opportunity to “change the topic” by discussing a different and less polarizing vaccine, such as RZV.
Private insurance for those 50-65 years of age and Medicare Part D coverage for those 65 years of age or older are effective ways of obtaining coverage for medications administered by a pharmacist, thus facilitating reimbursement to the entity providing the vaccine and minimizing out-of-pocket costs to patients.
At a time when we are all vigilant about severe illness, we should remind our patients that before COVID-19, there were other threats, and we must continue all efforts to stay as healthy as possible. When it comes to zoster reactivation, the best tool we have is prevention through vaccination.
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