New vaccination programme to protect against shingles
The DH, NHS England and Public Health England have introduced a new vaccination programme from 1 September 2013 to protect adults aged 70 years against herpes zoster, following a review of the available evidence by the Joint Committee on Vaccination and Immunisation.1
Eligible individuals should receive a single dose of the varicella zoster vaccine Zostavax by subcutaneous injection. This can be given to the patient at the same time as the seasonal influenza vaccine.
Zostavax should not be given to patients with a primary or acquired immunodeficiency state receiving immunosuppressive therapy (including high-dose corticosteroids but not topical/inhaled corticosteroids or low-dose systemic corticosteroids or in patients receiving corticosteroids as replacement therapy) with active untreated TB who have had an anaphylactic reaction to a previous dose of the vaccine, or to neomycin or gelatin.
A catch up-immunisation programme has been launched for people aged 79 years.
It is estimated that 30,000 cases of shingles occur in people in their 70s each year in England and Wales, with approximately one in 1,000 cases in adults aged over 70 years resulting in death. The vaccination programme is expected to prevent nearly 40% of cases in those aged over 70.
Oral ketoconazole suspended
The MHRA no longer recommends the use of oral medicines containing ketoconazole for the treatment of fungal infections, owing to an increased risk of liver damage.2
The risk of hepatic injury with oral ketoconazole is thought to be higher than that associated with other available antifungal treatments. The MHRA has issued the following advice for healthcare professionals:
- Patients currently taking oral ketoconazole for fungal infections should be identified and reviewed at a routine appointment.
- Topical ketoconazole formulations (such as creams, ointments and shampoos) may continue to be used because systemic absorption of these preparations is minimal.
The updated advice follows a previous licence restriction, which limited the use of ketoconazole to infections resistant to other antifungals that could not be treated topically because of the site, the extent of the lesion or the depth of infection, and only where the potential benefits outweighed the potential risks of hepatotoxicity.
1. NHS England, Public Health England, DH. Introduction of shingles vaccine for people aged 70
2. MHRA. Drug Safety Update, Volume 7 Issue 1, August 2013.