Laura Hurley, MD, MPH; Allison Kempe, MD, MPH
Potential Conflicts of Interest: None disclosed.
Hurley L., Kempe A.; Barriers to Herpes Zoster Vaccination. Ann Intern Med. 2010;153:418-419. doi: 10.7326/0003-4819-153-6-201009210-00015
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Published: Ann Intern Med. 2010;153(6):418-419.
We thank Dr. Opstelten and colleagues for their comments and agree that solving the financial and freezer storage issues we discovered would not remove all barriers to herpes zoster vaccine uptake in the United States. However, the results of our study and those of Opstelten and colleagues' study (1) differ in a few important ways that make direct comparison problematic. First, Opstelten and colleagues' study was done in the Netherlands, and the herpes zoster vaccine was not recommended there at that time; therefore, physicians and patients were probably not familiar with it. Our study was done in the United States at a time when the herpes zoster vaccine had been recommended for almost 2 years. Second, health care systems and financing of care differ between the Netherlands and the United States in ways that may markedly affect population responses. Third, the study by Opstelten and colleagues (1) presents the patient perspective, whereas our study presents the provider perspective. Although we did not find the perceived lack of serious sequelae from herpes zoster and postherpetic neuralgia to be a major barrier to administering herpes zoster vaccine to providers, U.S. patients could perceive it as a larger barrier. The 2007 National Immunization Survey—Adult (2), which provides some insight into the patient perspective of herpes zoster vaccination in the United States, found that 77.8% of respondents who had not yet received the herpes zoster vaccine would accept it (hypothetically) if recommended by their physician. It would be interesting to do a study in the United States similar to that of Opstelten and colleagues, where patients would have the option of receiving the herpes zoster vaccine for free, rather than theorizing on what patients might do if offered it, as in the National Immunization Survey—Adult survey.
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