HERPES ZOSTER VACCINATION

Transcription

1 HERPES ZOSTER VACCINATION

2 Herpes Zoster (shingles) is a reactivation of the varicella zoster infection in some-one who has previously had varicella(chicken pox) disease Painful, unilateral, self-limiting vesicular rash in a dermatomal distribution May have systemic symptoms such as headaches and malaise Pain may precede the rash

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4 Shingles complications can be serious 1-4 Shingles pain can be excruciating ( stabbing and burning ) 1,2 Ophthalmic zoster Can occur in up to 25% 2,3 Complications may include facial scarring and loss of vision 2,4 Stroke risk Shingles may also increase the risk of stroke in the following 6 months 5 There is a 63% higher risk in the 4 weeks after shingles vs. baseline period 5 1. Johnson R, et al. Int J Infect Dis 2007; 11(Suppl2): S Harpaz R et al. MMWR 2008 (June 6); 57 (RR-5): NCIRS Herpes Zoster Fact Sheet August Available at: Accessed February Yawn BP et al. Mayo Clin Proc 2013; 88: Langan SM et al. Clin Infect Dis 2014; 58:

5 Postherpetic neuralgia (PHN) is the most frequent debilitating complication of shingles 1 PHN can last for months, even years 2 Pain and nerve damage can begin before the shingles rash is visible 2 20% PHN may be severe 1,2 PHN patients report experiencing pain in the area of their shingles rash for an average of 3.5 years 3 Up to 20% of shingles sufferers may go on to develop PHN 1,4 1. Australian Technical Advisory Group on Immunisation (ATAGI). The Australian immunisation handbook 10th ed (August 2017 update). Canberra: Australian Government Department of Health, Oxman MN et al. Arvin AM et al, editors, 2000 p246/75 3. Serpell M et al. Health Qual Life Outcomes 2014; 12: Harpaz R et al. MMRW 2008 Jun 6; 57(RR-5):1-30

6 WHO IS AT RISK? 20-30% OF PEOPLE WILL DEVELOP SHINGLES IN THE LIFETIME MOST ARE OVER 50 95% OF THE POPULATION OVER 30 HAVE HAD VARICELLA AS A CHILD AND THEREFORE AT RISK INCREASES WITH AGE INCREASED IN IMMUNOSUPPRESSED POST HERPETIC NEURALGIA PHN HIGHEST OVER 70

7 ZOSTER VACCINATION ZOSTAVAX (MSD) HAS BEEN REGISTERED IN AUSTRALIA SINCE 2006 FOR ADULTS OVER 50 LIVE VACCINE 14X THAT OF CHICKEN POX VACCINE EFFICACY DECLINES WITH AGE PROTECTION FOR PHN IS THE SAME FOR THOSE AS FOR SOME-ONE IN 60S IF VACCINATED MAY STILL DEVELOP SHINGLES BUT LESS SEVERE AT THIS TIME BOOSTERS NOT ADVISED

8 WHO SHOULD BE VACCINATED? ZOSTAVAX FUNDED FOR ADULTS AGE 70 WITH A CATCH UP 71-79(TILL2021) PRIVATE SCRIPT COST APPROX. $200 OVER 79 PRIVATE SCRIPT THOUGH EFFICACY DIMINISHED RPBS WILL FUND VIA AUTHORITY SYSTEM (ALSO DTPA) THOSE OVER 50 WITH CHRONIC CONDITIONS PRIVATE SCRIPT HOUSEHOLD CONTACTS OF IMMUNOCOMPROMISED- PRIVATE SCRIPT

9 WHO SHOULD NOT BE VACCINATED? IMMUNOCOMPROMISED PATIENTS PREGNANT WOMEN ANAPHYLAXIS TO THE VACCINE OR COMPONENTS(INC GELALATIN OR NEOMYCIN)

10 BE ALERT SOME ELDERLY PATIENTS ARE REGULARLY TAKING CORTICOSTEROIDS AND/OR DMARDS THIS CAN INCLUDE PATIENTS WITH RA, IBD, SKIN CONDITIONS, RENAL DISEASE, MS AND OTHER AUTOIMMUNE CONDITIONS. A DETAILED MEDICATION HISTORY IS NEEDED BEFORE VACCINATION A NUMBER OF THESE DRUGS ARE PRESCRIBED BY THE SPECIALIST AND MAY NOT BE RECORDED IN THE MEDICATION LIST IF YOU HAVE ASSESSED AS NOT ELIGIBLE RECORD THIS SOMEWHERE CLEARLY SO THAT SOME-ONE ELSE DOES NOT VACCINATE THIS COULD INCLUDE IN WARNINGS COULD BE IN THE IMMUNISATION SECTION AS REFUSED ON MEDICAL GROUNDS

11 CAN BE GIVEN WITH INFLUENZA VACCINATION BUT NOT PNEUMOCOCCAL AS REDUCES IMMUNOGENICITY SEPARATE FROM OTHER LIVE VACCINES FOR 4 WEEKS IF NOT ON SAME DAY SINGLE DOSE AT THIS STAGE BOOSTERS NOT RECOMMENDED SOME STUDIES ON BOOSTERS AT 10 YEARS SYSTEMIC ANTIVIRALS MAY DECREASE VACCINE EFFECTIVENESS. WHERE POSSIBLE ANTIVIRALS SHOULD BE STOPPED FOR 48 HOURS BEFORE VACCINATION AND WITHHELD FOR AT LEAST 14 DAYS

12 Number of people (millions) ADULT VACCINATION RATES ARE WELL BELOW PAEDIATRIC VACCINATION RATES 1 Number of Australians eligible for vaccination under the National Immunisation Program by age and vaccination status, each year 1 Fully vaccinated Unvaccinated or incompletely vaccinated NIP eligible adults Of the estimated 4.1 million unvaccinated NIP eligible Australians each year, approximately 3.8 million (92%) are adults 1 <6 years years 65 years^ Medically at risk 18 years* Adapted from Menzies R et al Med J Aust Age group ^ Indigenous adults <65 years Would we accept these rates for children? Does this reflect vaccination rates in your clinical practice? For pneumococcal and influenza vaccination * Medically at-risk children aqed 6 months to 17 years are also funded but are not included in these numbers 1. Menzies R et al Med J Aust 2017; 206:

13 ZOSTAVAX UPTAKE IN THOSE AGED YEARS UNPRECEDENTED UPTAKE AT LAUNCH AT JUNE 2017 DOSES DISTRIBUTED REFLECTED 54% OF COHORT SIZE 1 AT DECEMBER 2017 DOSES DISTRIBUTED REFLECTED 60%. 1 VACCINE UPTAKE HAS SLOWED DOWN SIGNIFICANTLY. HOW CAN WE ENCOURAGE THE REMAINING ELIGIBLE PATIENTS TO GET VACCINATED? 1. Seqirus Data on file

14 THE MOST IMPORTANT PREDICTOR OF VACCINATION IS YOUR RECOMMENDATION 1,2 Factors that increase HZ vaccine uptake 3 Factors that decrease uptake 3 Older age Female Higher level of education Regularly gets other vaccines Higher awareness of shingles vaccine Belief that shingles can be a severe condition Has a usual GP GP recommendation to get vaccine Family or friends previously affected by shingles Availability of vaccine Low perceived risk of getting shingles Beliefs that: the vaccine is unnecessary, they never get sick, they already have good immunity, natural immunity is better Concerns about: vaccine efficacy, adverse effects, allergic reaction to vaccine, vaccine causing shingles GP did not discuss need for vaccine Difficulty getting to GP 1. Litt JCB, et al. Int J Infect Diseases 2014; 21: Menzies R et al Med J Aust 2017; 206: Litt JCB, et al. Update on Herpes Zoster. Health Ed 2017

15 RESOURCES FOR IMMUNISATION PROVIDERS THE AUSTRALIAN IMMUNISATION HANDBOOK, 10TH EDITION THE MOST UP-TO-DATE CLINICAL RECOMMENDATIONS ARE CONTAINED IN THE ONLINE VERSION OF THE HANDBOOK 0-HOME IMMUNISE AUSTRALIA WEBSITE FOR MORE DETAILED INFORMATION AND COMPLETE REFERENCE LIST SEE THE NCIRS FACTSHEET ZOSTER VACCINE FOR AUSTRALIAN ADULTS: INFORMATION FOR IMMUNISATION PROVIDERS

16 Tasmanian HealthPathways is an online portal designed to be used at the point of care. It aims to guide best-practice assessment and management of common medical conditions and is accessible to GPs and other Tasmanian health care providers. There is a suite of immunisation pathways with up-to-date information along with clinical and patient resources. Tasmanian HealthPathways Quick User Guides are available today