Herpes Zoster Vaccine Is Tolerated Well but Not Disseminated Widely

In older adults, herpes zoster is associated with pain and disability that can endure as postherpetic neuralgia, and treatments for acute and chronic symptoms are suboptimal. The herpes zoster vaccine (Zostavax) — which lowers the incidence of zoster by 50% and is covered by Medicare — would seem to be most welcome, but uptake is estimated at 7% or less. In two studies, researchers address possible barriers to patient receipt of this vaccine.

Investigators present a detailed safety analysis from the industry-sponsored randomized placebo-controlled trial that established the vaccine's efficacy: 38,546 immunocompetent adults at 22 U.S. centers were followed for a mean 3.4 years (JW Gen Med Jun 14 2005). Serious adverse events did not differ by group (1.4%) nor did hospitalization or death rates. Injection-site adverse effects were more common with active vaccine than with placebo (48% vs. 16%). Developing herpes zoster within 42 days after vaccination was more common in placebo recipients (24 vs. 7 cases), and no zoster case was attributed to the vaccine strain.

In another study, investigators surveyed 598 U.S. general internists and family physicians (response rate, 72%). Almost half of respondents stocked the vaccine and administered it in the office, but 36% administered it only after patients had purchased it at a pharmacy. Although 91% of physicians strongly recommended influenza and pneumococcal vaccination, only 41% strongly recommended herpes zoster vaccination. Only 45% knew the vaccine was reimbursed through Medicare Part D. Substantial proportions of physicians reported reimbursement complexity as a major barrier (43% for Medicare, 33% for private insurance). Uncommon barriers were concerns about efficacy or safety of the vaccine or incidence of zoster.