Thousands of immunocompromised Kiwis to benefit from new vaccine funding

Up to 15,000 immunocompromised Kiwis are set to benefit over the next two years from widened access to a publicly funded vaccine, which can help protect patients from shingles, a disease that can cause a blistering rash, intense burning, and shock-like pain.^[1][2]

Herpes Zoster reactivation, also known as shingles, is more common, more severe and longer lasting in people with poor immunity and the elderly.^[3]

Shingles is a viral infection caused by the reactivation of the varicella-zoster herpes virus, the same virus that causes chickenpox.

Almost all adults over 50 already have the virus that causes shingles lying dormant in their bodies due to an initial chickenpox infection. Around a third of these will develop shingles in their lifetime when the virus reactivates.^[4] However, research has shown the risk of shingles can be up to seven times higher in immunocompromised patients compared to immunocompetent individuals. In addition, this patient group has a greater risk of developing complications and more severe diseases. The virus can enter the bloodstream causing illness or result in inflammation of organs such as the lungs or liver.^[5][6]7

The most common long-term complication is long lasting nerve pain called postherpetic neuralgia (PHN). PHN occurs when nerve fibres are damaged during a shingles outbreak. Damaged fibres are unable to send messages from the skin to the brain effectively, causing pain that can last for months or years.⁸

From 1 July 2024 publicly funded access to a vaccine for the prevention of shingles will be widened to include immunocompromised people aged 18 years or older who are; pre and post a solid organ transplant, haematopoietic stem cell transplant or cellular therapy, those with haematological malignancies (blood cancer), those living with poorly controlled HIV infection, those receiving disease-modifying anti-rheumatic drugs (DMARDs) for specific conditions (polymyalgia rheumatica, systemic lupus erythematosus, rheumatoid arthritis), people with primary immunodeficiency, and stage 4 and 5 chronic kidney disease including patients on dialysis.⁹

Dr Andrew McNally, Medical Advisor at Kidney Health NZ, says shingles poses a significant risk for Kiwis who have chronic kidney disease, autoimmune diseases, or are the recipients of organ transplants.¹⁰

“These patients have conditions that weaken their immune systems or are on long-term medications which can dampen their immune responses, so shingles has a greater risk of developing.¹¹

“In addition to PHN these patients are at risk of further complications, including secondary bacterial skin infection at the initial site of the shingles rash. The virus can on rare occasions also reactivate systemically and involve the brain (meningoencephalitis), eye (herpes zoster opthalmicus or ocular shingles).¹²¹³

“Herpes Zoster and shingles can be a devastating disease, particularly for those more vulnerable members of the community. It’s important that patients who have advanced kidney disease, are on dialysis, or are on immunosuppressant treatment due to an organ transplant or autoimmune disease, are protected from shingles and its associated complications,” he says.¹⁴

Brett Marett, Medical Director at GSK says the widened access to Shingrix will help protect several of our most vulnerable patient groups from a potentially debilitating yet preventable disease.

"This decision will provide much-needed protection against shingles for thousands of immunocompromised New Zealanders. We are pleased to partner with Pharmac to expand access to this vital vaccine, helping to prevent the severe and painful complications associated with shingles in those most at risk," he says.