The herpes zoster vaccine (Zostavax) is effective, well tolerated, and recommended for routine administration by national guidelines. The vaccine has been shown to lower the incidence of zoster by 50%. However, 7% or less of older adults receive it.
In older adults, herpes zoster is associated with pain and disability that can endure as postherpetic neuralgia, and treatments can be ineffective.
Investigators presented a detailed safety analysis from the industry-sponsored randomized placebo-controlled trial that established the vaccines efficacy: 38,546 immunocompetent adults at 22 U.S. centers were followed for a mean of of 3.4 years. Serious adverse events did not differ by group (1.4%) nor did hospitalization or death rates. Developing herpes zoster within 42 days after vaccination was more common in placebo recipients (24 vs. seven 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. 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).
More widespread use likely will depend on obtaining better data, lessening financial barriers, and overcoming the usual challenges of delivering preventive services for adults, according to researchers.