6 February 2020

Warning over low Zostavax coverage

Aged Care Immunology

People aged 85 and older have a 50% chance of developing shingles, but only one third of elderly patients are participating in the free vaccination program targetting the virus, experts say.

Records from the Australian Immunisation Register (AIR) show despite the herpes zoster (Zostavax) vaccine being fully subsidised for every 70 year old since 2016, uptake has been slow.

In an article recently published in Australian Prescriber, researchers from the National Centre for Immunisation Research and Surveillance expressed disappointment that only 34% of those aged 70, and only 26% of those aged 71 to 79, received Zostavax in the first 17 months of the vaccination program.

“These low estimates of coverage are likely, in part, due to under-reporting by GPs as the number of Zostavax doses distributed under the National Immunisation Program was almost double the number recorded in the Australian Immunisation Register,” the authors said.

In Australia, around 120,000 new cases of shingles occur each year and make up approximately one in 1000 GP presentations.

But it seems public awareness of the virus is minimal, with one GP telling The Medical Republic it was a “low priority disease” for some older patients.

The live attenuated vaccine offers 51% protection against shingles and 67% against postherpetic neuralgia in three years of follow up. In addition, individuals who are vaccinated and go on to have the virus will experience a less severe illness with fewer complications.

The authors pointed out that the vaccine, while not highly efficacious, was an important strategy given the limited impact of currently available treatments.

Dr Sanjay Jayasinghe, a medical epidemiologist and research fellow at the NCIRS, said it was important to remember to offer Zostavax, and record any administered vaccines in the AIR.

“This vaccine can be given with other vaccines such as the flu vaccine and the pneumococcal vaccine, which people in this age group may be more familiar with,” he said. “When patients come for their flu vaccine, it might be a good opportunity to see if they have also been administered Zostavax.”

Dr Jayasinghe also warned that while patients aged 70 would continue to access the vaccine for free under the NIP, the catch up program for those aged 71-79 would be finishing in October next year.

“It’s important to make sure the catch-up is offered now to any eligible patients while it is still subsidised,” he said.

A new vaccine for shingles has been listed recently by the TGA for use in Australia but a global supply shortage has delayed its entry to the local market.

The two-dose vaccine, called Shingrix, provides 97% protection against shingles and postherpetic neuralgia over more than three years.

Shingrix is also suitable for immunocompromised patients who are unable to receive the live Zostavax vaccine.

For now though it is unclear if Shringrix will be able to prove cost effectiveness for the NIP, and Zostavax remains the endorsed vaccine for shingles protection.

Australian Prescriber, 3 February   

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