Barriers to the use of herpes zoster vaccine

The Children's Hospital of Denver, University of Colorado Denver, USA.
Annals of internal medicine (Impact Factor: 16.1). 05/2010; 152(9):555-60. DOI: 10.1059/0003-4819-152-9-201005040-00005
Source: PubMed

ABSTRACT The herpes zoster vaccine is the most expensive vaccine recommended for older adults and the first vaccine to be reimbursed through Medicare Part D. Early uptake has been 2% to 7% nationally.
To assess current vaccination practices, knowledge and practice regarding reimbursement, and barriers to vaccination among general internists and family medicine physicians.
Mail and Internet-based survey, designed through an iterative process and conceptually based on the Health Belief Model.
National survey conducted from July to September 2008.
General internists and family medicine physicians.
Survey responses on current vaccination practices, knowledge and practice regarding reimbursement, and barriers to vaccination.
Response rates were 72% in both specialties (301 general internists and 297 family medicine physicians). Physicians in both specialties reported similar methods for delivering vaccine, which included stocking and administering the vaccine in their offices (49%), referring patients to a pharmacy to purchase the vaccine and bring it back to the office for administration (36%), and referring patients to a pharmacy for vaccine administration (33%). Eighty-eight percent of providers recommend herpes zoster vaccine and 41% strongly recommend it, compared with more than 90% who strongly recommend influenza and pneumococcal vaccines. For physicians in both specialties, the most frequently reported barriers to vaccination were financial. Only 45% of respondents knew that herpes zoster vaccine is reimbursed through Medicare Part D. Of respondents who began administering herpes zoster vaccine in their office, 12% stopped because of cost and reimbursement issues.
Survey results represent reported but not observed practice. Surveyed providers may not be representative of all providers.
Physicians are making efforts to provide herpes zoster vaccine but are hampered by barriers, particularly financial ones. Efforts to facilitate the financing of herpes zoster vaccine could help increase its use.
Centers for Disease Control and Prevention.

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    • "De façon évidente, cela limite grandement son utilisation car bon nombre de médecins n'ont pas à disposition le congélateur, voire le réfrigérateur nécessaire au respect de la chaîne du froid [17]. Le problème du remboursement du vaccin n'a pas non plus contribué à faciliter son utilisation [62]. Aux États-Unis, le programme Medicare ne rembourse les 153,93 $ du vaccin qu'après obtention d'un accord préalable . "
    NPG Neurologie - Psychiatrie - Gériatrie 06/2012;
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    ABSTRACT: Herpes zoster is a common disease among older individuals, affecting approximately 25% of people in their lifetime and resulting in appreciable morbidity. The risk of zoster increases sharply with age and immunosuppression, yet relatively little is known about other risk factors for zoster. A vaccine for zoster is now available that holds the potential to reduce incidence of zoster and its complications. In this review, the recent literature on zoster incidence and potential risk factors for the disease are summarized. Current methods of preventing zoster and its associated morbidity are discussed, including zoster vaccine and the use of antivirals.
    03/2012; 1(1). DOI:10.1007/s13671-011-0004-4
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    ABSTRACT: Shingles (herpes zoster [HZ]) is a localized, generally painful and debilitating disease that occurs most frequently among older adults. It is caused by reactivation of varicella-zoster virus. HZ causes substantial morbidity, especially among older adults. The vaccine to prevent HZ was approved by Food and Drug Administration and recommended by the Advisory Committee for Immunization Practices for people aged ≥60 years in 2006 (these recommendations were published in 2008). To examine HZ vaccination among people aged ≥60 years in the U.S. in 2008. Data from the 2008 National Health Interview Survey among people aged ≥60 years were analyzed in 2010. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with HZ vaccination. Potential missed opportunities also were assessed. By 2008, only 6.7% (95% CI=5.9%, 7.6%) of adults aged ≥60 years reported having had HZ vaccination. The level of HZ vaccination coverage was lower (4.7%) among people aged 60-64 years compared to people aged 65-74 years (7.4%); 75-84 years (7.6%); and ≥85 years (8.2%). Coverage was statistically higher for non-Hispanic whites (7.6%) compared with non-Hispanic blacks (2.5%) and Hispanics (2.1%). Among people aged ≥60 years who reported never receiving HZ vaccination, 95.1% reported at least one missed opportunity to be vaccinated. People more likely to report ever having been vaccinated were older, female, non-Hispanic white, married, more educated, and reporting received influenza vaccination in the past year. By 2008, HZ vaccination coverage was 6.7%. The coverage level was low among all groups, but it was lowest among minority groups. Increased efforts are needed to remove barriers and to enable HZ vaccination among all adults aged ≥60 years.
    American journal of preventive medicine 02/2011; 40(2):e1-6. DOI:10.1016/j.amepre.2010.10.012 · 4.28 Impact Factor
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