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4 May 2010, Vol 152, No. 9>
Summaries for Patients | 4 May 2010

Barriers to the Use of a Vaccine to Prevent Shingles FREE

[+] Article and Author Information

The summary below is from the full report titled “Barriers to the Use of Herpes Zoster Vaccine.” It is in the 4 May 2010 issue of Annals of Internal Medicine (volume 152, pages 555-560). The authors are L.P. Hurley, M.C. Lindley, R. Harpaz, S. Stokley, M.F. Daley, L.A. Crane, F. Dong, B.L. Beaty, L. Tan, C. Babbel, L.M. Dickinson, and A. Kempe.


Ann Intern Med. 2010;152(9):I-36. doi:10.7326/0003-4819-152-9-201005040-00002
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What is the problem and what is known about it so far?

Shingles is a rash that usually starts with localized pain and is followed by blisters that eventually burst and then crust over and heal. This process takes several weeks. After the rash heals, some people have persistent pain that can be severe and difficult to manage. The herpes zoster virus that causes shingles is the same virus that causes chickenpox, and only people who have had chickenpox get shingles. Research has shown that a vaccine to prevent shingles will prevent about half of cases of shingles and persistent pain. The U.S. Food and Drug Administration approved the vaccine in 2006, and experts recommend that it be given to people who have had chickenpox, have a competent immune system (the vaccine contains a live virus), and are 60 years of age or older (shingles is more common in older people). The problem is that fewer than 10% of the people who are eligible for the vaccine have received it.

Why did the researchers do this particular study?

To find out why so few eligible people have gotten the herpes zoster vaccine.

Who was studied?

301 general internists and 297 family medicine doctors.

How was the study done?

The researchers sent surveys to the doctors as e-mail messages or by standard mail.

What did the researchers find?

72% of doctors responded. Of these doctors, 93% make the vaccine available to their patients—49% by stocking the vaccine in the office and administering it there, 36% by asking the patient to buy the vaccine in a pharmacy and then administering it in the office, and 33% by referring patients to a pharmacy for vaccine administration (some physicians provide multiple options). 12% of doctors who started administering vaccine in the office have stopped. Doctors identified financial reasons for infrequent use of the herpes zoster vaccine. It is more expensive than most other adult vaccines, with a price of about $200, which may not be covered by insurance. Medicare pays for it with the system it uses to pay pharmacists (Part D), which most doctors are not familiar with, instead of the system it uses to pay doctors for nearly all other services (Part B).

What were the limitations of the study?

Some of the results are self-reported behavior, not observed behavior. The doctors who responded to the survey may not represent other doctors.

What are the implications of the study?

It may be necessary to change the way this vaccine is paid for to have more eligible people get the vaccine.

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Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general jounals
BMJ 2010;341:c5893-c1494.

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