When it comes to protecting older patients from the ravages of shingles and its sequelae, family physicians have no better weapon in their arsenal than the herpes zoster vaccine. But, like every other vaccine, it only works if patients get it.
Unfortunately, a recent study(www.plosmedicine.org) found that despite the documented effectiveness of the herpes zoster vaccine in preventing shingles and its most common complication -- postherpetic neuralgia (PHN) -- few people are receiving the immunization.
The study, published in the open-access online journal PLoS Medicine, looked at more than 765,000 randomly selected Medicare beneficiaries ages 65 and older who either received or did not receive the zoster vaccine between Jan. 1, 2007, and Dec. 31, 2009.
Among the study's findings:
- Vaccine uptake was low overall, at 3.9 percent, and was lowest among blacks (0.3 percent) and those with low income (0.6 percent).
- The shingles incidence rate was 10.0 per 1,000 person-years among unvaccinated participants and 5.4 per 1,000 person-years among vaccinated participants, yielding an overall vaccine effectiveness level of 48 percent.
- Vaccine effectiveness against incident herpes zoster among immunosuppressed individuals was lower, at 37 percent, but effectiveness against PHN was 59 percent.
"Despite strong evidence supporting (the vaccine's) effectiveness, clinical use remains disappointingly low, with particularly low vaccination rates in particular patient groups," the authors wrote in the study conclusion. "This study shows that herpes zoster vaccination is associated with a reduction in PHN in routine clinical use.
"As PHN is the major complication of herpes zoster and is associated with highly significant morbidity and adverse impacts on quality of life, substantial efforts are needed to increase vaccine use in routine care of elderly individuals."
According to an editorial note that accompanied an article in the Feb. 1 issue of the CDC's Morbidity & Mortality Weekly Report, adult coverage levels for the herpes zoster vaccine, as well as the pneumococcal and hepatitis B vaccines, remain "unacceptably low" and are well below the respective target levels(healthypeople.gov) set by HHS' Healthy People 2020 initiative. This poor showing further highlights the need to step up efforts to increase adult vaccination coverage. The CDC also noted that physician vaccination recommendations are associated with patients actually getting vaccinated.
"Routine assessment of adult patient vaccination needs, recommendation and offer of needed vaccinations for adults should be incorporated into routine clinical care of adults," the CDC said. "The adult immunization schedule, updated annually, provides current recommendations for vaccinating adults and a ready resource for persons who provide health care services for adults in various settings."