23 May 2018

Patients dismissing shingles risk, along with the vaccine

Clinical Immunology

There are still no hard numbers on the uptake of Zostavax since the vaccine was introduced for older people in 2016, but GPs say the demand is low.

Some older patients were disinterested in Zostavax and seemed unaware of the potentially serious complications from shingles, Dr Sarah Chu, a Brisbane GP, told The Medical Republic.

“Not everyone thinks shingles is a high priority disease,” Dr Chu said.

“I don’t think they realise how bad some of the complications can be until you really list it out.”

Patients need to be told the painful rash of herpes zoster can be debilitating in older people. 

And around 10-25% of people aged over 50 with shingles will develop post-herpetic neuralgia, which can substantially diminish a person’s quality of life. The risk of shingles increases with age, with about half of people aged 85 having experienced shingles in their lifetime.

Zostavax reduces the risk of shingles by around 50% in older people, and is currently free to people aged 70-79 in Australia. But, for a number of reasons, older patients weren’t “beating the doors down” for Zostavax, Dr Joe Kosterich, a GP based in Perth, said.

“That age group doesn’t tend to think so much about immunisation,” he said.  

“Childhood immunisation has been more of a focus, society-wise.” 

Older people often have other medical issues that seem more pressing than vaccinations. 

“If somebody has got diabetes and asthma and heart failure and five other things then maybe at the end of the consultation [it’s a] stretch and to say, ‘Oh, by the way, let’s talk about the shingles vaccine as well’,” he said.

“So, you can see how in the real world that’s going to happen at times.”

Zostavax vaccinations were being recorded on the Australian Immunisation Register, but no uptake figures had been released yet, Dr Rob Menzies, a UNSW researcher who specialises in vaccine preventable disease epidemiology, said.

A spokesperson for Seqirus said that the company had distributed enough vaccines to cover 55% of Australians aged 70-79. The spokesperson said it was not known whether these vaccines had gone into patients’ arms.

Professor Paul Van Buynder, the chairman of the Immunisation Coalition, said there was not a lot of ordering activity because a lot of shingles vaccines were sitting in GP fridges. “Coverage may only be around 30%,” he said.

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Dr Lamorna Osborne
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Dr Lamorna Osborne
2 months 24 days ago

Our main problem in NSW was the delayed delivery of the vaccine . The publicity on TV and radio came out when there was initially no supply available , followed by ten vaccines per practice per month , for a while and now we have it but patients have lost interest . For some unknown reason ACT got all of theirs at the correct time . Patients hear about the immunosuppressed accidentally being given a live vaccine with disastrous consequences thanks to being a live virus and also much higher dose than the kids get.

Lou Lewis
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Lou Lewis
2 months 28 days ago
One of the reasons that ZOSTAVAX has had had such a low uptake by the elderly is that the contraindications, side-effects and the precautions has terrified bejesus out of them. I personally know of a patient who had the vaccine and for the next three months was suffering from almost unbearable arthralgia and it affected his playing bowls, and have heard of other similar cases with extreme myalgia, and patients talk about their health and any bad side effects from drugs and the ZOSTAVAX vaccine, and personally I am rather hesitant to give it in some of my elderly patients… Read more »
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