Study flags knowledge gaps for shingles vaccine

A recent study has highlighted ‘notable gaps’ in knowledge among GPs about the shingles vaccine being used in a Federal Government-funded program to protect older people.
 
Since November 2016, every person aged 70 has had free access to the Zostavax, a live attenuated herpes zoster vaccine, under the National Immunisation Program (NIP).
 
A catch-up program was introduced at the same time for those aged 70−79, initially for five years then extended until October 2023.
 
While the vaccine is safe, its use is contraindicated in severely immunocompromised people.
 
However, research carried out by the National Centre for Immunisation Research and Surveillance (NCIRS) suggests that around one in 10 GPs may be unaware that it should not be given to those in the latter group.
 
The findings, published in the Australian Journal of General Practice (AJGP) in July, were based on a survey distributed by a private health education provider, which had 502 GP responses.
 
While most stated they knew Zostavax is funded and recommended for adults aged 70−79 – the age bracket included in the NIP – around 10% wrongly said that immunocompromise is not a contraindication to being vaccinated with Zostavax.
 
Around 8% stated they did not know.
 
Five clinical situations involving Zostavax were also put to the GPs who responded to the survey, with the proportion of correct responses varying from 25% to 82% across the different scenarios.
 
‘The safety profile of Zostavax is well documented, with serious adverse events infrequent and predominantly in individuals contraindicated to receive the vaccine,’ the authors wrote.
 
‘While most GPs surveyed had good knowledge, notable gaps were identified.’
 
The study followed a similar study conducted in 2017 which also identified gaps in understanding.
 
From 2017 to 2020, three immunocompromised people died in Australia after receiving the Zostavax vaccine.
 
‘Further efforts are needed to promote awareness of recommendations, particularly for immunocompromised individuals,’ the AJGP authors state.
 
Associate Professor Frank Beard was the lead author on the study.
 
‘Each person should be assessed on a case-by-case basis,’ he told newsGP.
 
‘There is a screening tool which was developed, which goes through all the questions and screening steps. All patients should go through that screening tool.
 
‘Then, if there’s any uncertainty, the recommendation is that GPs should discuss with the person’s treating physician or an immunisation specialist.’
 
The authors also highlight another vaccine, which is not funded under the NIP, that is now available in Australia.
 
‘The availability of Shingrix, a non-live recombinant subunit zoster vaccine, in the private market provides an alternative, especially for immunocompromised patients,’ they stated.
 
The Australian Technical Advisory Group on Immunisation (ATAGI) states that for those aged 50 and above ‘Shingrix is preferred over Zostavax for prevention of herpes zoster and its complications, due to its higher efficacy’.
 
‘In immunocompetent adults aged over 50 years, Zostavax remains a readily available and effective alternative vaccine to reduce the risk of herpes zoster.’

In a statement sent to newsGP, Zostavax market authorisation holder CSL Seqirus said it ‘is committed to supporting healthcare professionals with the safe and appropriate administration of Zostavax,’ including with safety mailers and resources sent to GPs and clinics, clinical meetings, online modules and product literature. 

Read the full ATAGI statement on the use of zoster vaccines in adults in Australia.
 
A screening table for the use of Zostavax is available on the Australian Immunisation Handbook website.
 
Editor’s note: This article was updated on 11.08.2022 to include reference to a statement supplied by Zostavax market authorisation holder CSL Sequirus. 

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herpes zoster immunocompromised National Immunisation Program shingles vaccine