PBAC backs Shingrix for immunocompromised adults

By Geir O'Rourke

15 Jan 2024

Adult patients on immunosuppressants, biologics and cancer treatments would be eligible for subsidised access to Shingrix (herpes zoster) vaccine, under the latest recommendation from PBAC.

The expert committee has also backed the addition of a new 20-valent pneumococcal vaccine for children and a meningococcal ACWY jab for adolescents on the NIP, following its most recent meeting.

It comes after funding for Shingrix, a varicella zoster virus recombinant vaccine, was expanded in November to include all Australians over 65 (and over 50 for Indigenous patients).

Eligibility also included immunocompromised adults aged 18 years and over with haemopoietic stem cell transplants, solid organ transplants, haematological malignancy and advanced or untreated HIV.

However, consideration of the broader population of immunocompromised adults was deferred by the committee until its November 2023 meeting.

Findings included that the vaccine was likely to be cost-effective at the requested cost per dose in the moderate and high risk populations aged 18-64 years, the PBAC reported in an outcome statement (link here).

The move has been noted by advocacy groups such as MS Australia, which noted that previously, Zostavax, which is a live-attenuated vaccine against shingles, was part of the NIP and was not recommended for people who are immunocompromised.

Those with contraindications were paying over $300 for each of the two doses of Shingrix.

Eligibility would be as defined by the Australian Technical Advisory Group on Immunisation (ATAGI) and include:

  • Those with acute or chronic haematological malignancies,
  • HIV infection (with CD4+ cell count < 200/ µL),
  • Inborn errors of immunity (including x-linked agammaglobulinemia, severe combined immunodeficiency, chronic granulomatous disease) and
  • Stage 5 kidney disease or on dialysis.

Beyond, patients on the following therapies would be eligible such as:

  • Cellular therapies,
  • B and Tcell targeted monoclonal antibody therapies,
  • conventional chemotherapy for haematological cancers or solid organ tumours,
  • Immunosuppressive therapy to prevent organ rejection,
  • Some conventional immunosuppressive agents (including high dose methotrexate, mercaptopurine, azathioprine, mycophenolate, calcineurin inhibitors, mTOR inhibitors, cladribine),
  • Some biologic therapies (including TNF-α inhibitors, abatacept, dupilumab, mepolizumab, tocilizumab),
  • Immunomodulatory drugs (including sphingosine-1-phosphate inhibitors)
  • Some oral small molecule targeted therapies (including JAK inhibitors, BTK inhibitors, BCR-ABL inhibitors).

Other vaccines recommended

The PBAC also recommended the listing of Menveo, a vaccine with meningococcal serogroup A, C, W-135 and Y oligosaccharides, on the NIP for adolescents.

It said its advice was based on, among other matters, its assessment that the cost-effectiveness of Menveo solution for injection would be acceptable if it were cost-minimised against the nominated comparators, Menveo solution and powder for reconstitution and Nimenrix.

Meanwhile, the 20-valent pneumococcal conjugate vaccine Prevenar 20 (Pfizer), received the green light for addition to the NIP for paediatric populations.

Eligibility would follow the criteria in place for the currently available 13- and 15-valent vaccines.

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