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[Shingrix photo] KEY POINTS Non-live, recombinant subunit vaccine First non-live zoster vaccine to market FDA-approved in October 2017 for: Prevention of shingles (herpes zoster) in people aged 50 years or older In October 2017 the CDCs Advisory Committee on Immunization Practices (ACIP) voted that Shingrix is recommended for healthy adults aged 50 years and older to prevent shingles and related complications Shingrix is recommended for adults who previously received the current shingles vaccine (Zostavax) to prevent shingles and related complications Shingrix is the preferred vaccine for preventing shingles and related complications Not indicated for prevention of chickenpox Efficacy exceeded 90% in phase-III trials which got it FDA-approved Given in two intramuscular doses Common side effects: muscle pain, headache, shivering, fever, upset stomach, tiredness, injection site pain, injection site redness, or injection site swelling Favorable data exists for: Adults older than 70 years Immunocompromised persons Prolonged immunogenicity and safety Reportedly CDC has recommended Shingrix over Zostavax for adults over 50 (including in persons already given Zostavax), however an official statement from CDC has yet to be released as of 26 October 2017 Cost data is pending RESOURCES Shingrix Package Insert Shingrix FDA Approval Letter CDC Shingles (Herpes Zoster) Webpage CDC Shingles/Herpes Zoster Vaccine Recommendations Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older

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In adult patients with T2DM, intramuscular injections (eight to 10 loading injections of 1,000 g each over one to two weeks, followed by monthly 1,000-g injections) or oral vitamin B12 1,000 to 2,000 g daily are sufficient to correct vitamin B12 deficiency.9 Patients should be monitored for response to therapy