Australia urged to act on low zoster vaccine uptake

Experts are calling for a major push to encourage uptake of herpes zoster vaccination, with most elderly Australians and people in high-risk categories still at risk of the disease.

They say zoster vaccine coverage is also much lower than in comparable countries like the UK, where about three quarters of patients aged in their 70s have been vaccinated against the virus.

By contrast, 2019-20 estimates suggest only 47% of adults in the same age bracket here have received herpes zoster (HZ) vaccination, falling to 30% in all those aged 65 and over.

Researchers from the University of NSW Kirby Institute examined the results of three online surveys conducted in 2019 and 2020 for answers on what is holding back uptake.

They found those who were up to date on other vaccines were better than four times more likely to have received an zoster vaccine.

The same tendency also appeared in patients with a history of conditions such as cancer and stroke, who were 2.26 times more likely to have been vaccinated against the virus.

On the other side of the equation, patients who were daily smokers were only half as likely to be vaccinated, the researchers reported in Vaccine (link here).

There was no association with cardiovascular disease, chronic lung disease or immunocompromising conditions.

The researchers also looked at potential barriers to vaccination such as distrust of vaccines in general and “preferring to develop immunity naturally”, both of which were linked with significantly lower vaccination rates.

But they found no positive association between vaccination and other perceived obstacles like fear of needles, difficulties getting an appointment, time or mobility issues, nor did previous bad experiences with vaccines appear to be a significant issue.

The researchers acknowledged the zoster vaccine was only added to the National Immunisation Program (NIP) in 2016 and restricted to patients aged 70, although a catch-up program has been also funded.

Nevertheless, there had already been a significant decline in prescriptions for herpes zoster antivirals, “suggesting that the program is effective at decreasing the incidence of [herpes zoster]”, they wrote.

“The need to increase [zoster] vaccination uptake has never been greater,” the authors added, given the significant increase in disease incidence for the last several decades.

“Although it is often regarded as a mild illness, herpes zoster results in thousands of hospitalisations in Australia each year,” they wrote.

“In addition, treatment and hospitalisation for post-herpetic neuralgia results in significant economic burden. Given the ageing population of Australia and increasing rates of immunosuppression, the incidence of herpes zoster, is likely to continue to increase without intervention.”

Currently the single dose live attenuated zoster vaccine Zostavax is available under the NIP for immunocompetent people turning 70.  The alternate two-dose recombinant vaccine Shingrix is suitable for immunocompromised people but is not government funded and costs around $250 per dose on private prescription.

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