Shingles vaccination for individuals with bleeding disorders
- individuals with bleeding disorders may be vaccinated intramuscularly if, in the opinion of a doctor familiar with the individual’s bleeding risk, vaccines or similar small volume intramuscular injections can be administered with reasonable safety by this route
- if the individual receives medication or treatment to reduce bleeding, for example treatment for haemophilia, intramuscular vaccination can be scheduled shortly after such medication or treatment is administered
- individuals on stable anticoagulation therapy, including individuals on warfarin who are up to date with their scheduled international normalised ratio (INR) testing and whose latest INR was below the upper threshold of their therapeutic range, can receive intramuscular vaccination
- if in any doubt, consult with the clinician responsible for prescribing or monitoring the individual’s anticoagulant therapy
- on occasion the treating clinician may conclude, in discussion with the patient, that the benefit of protection against shingles could outweigh the increased risk of a transient local reaction with intramuscular immunisation
- for administration of the vaccination, a fine needle (equal to 23 gauge or finer calibre such as 25 gauge) should be used for the vaccination, followed by firm pressure applied to the site (without rubbing) for at least 2 minutes
Subcutaneous administration is off-label and a Patient Specific Direction (PSD) would be required (1).
The individual or carer should be informed about the risk of haematoma from the injection.
Reference:
- UK Health Security Agency (August 23rd 2024). Shingles immunisation programme: information for healthcare practitioners.