Despite the reduction of morbidity associated with use of the herpes zoster vaccine, a significant number of adults 60 years and older remain unvaccinated for shingles, according to research published in the American Journal of Preventive Medicine.1
Peng-jun Lu, MD, PhD, of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC), and colleagues used data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) to assess national and state-specific shingles vaccination coverage in adults 60 years of age or older.
BRFSS data is collected via a continuous population-based telephone survey, with participants randomly selected using a multistage cluster design. To assess shingles vaccination rates, survey respondents were asked “Have you ever had the shingles or herpes zoster vaccine?”with respondents who answered “yes” considered vaccinated. Participants who responded with “don’t know” or who declined to answer were excluded from the analysis.
A total of 208,505 adults 60 years and older participated in the 2014 BRFSS; 1.7% (n=3486) of participants were excluded. Survey respondents were majority female (54.8%), white (77.5%), and between the ages of 60-74 (70%). Most had a college or technical school education or higher (54.4%) and a household income greater than $50,000 (61.5%); 74.7% considered their health status to be “excellent,” “very good,” or “good.”
Among adults 60 years and older, shingles vaccination coverage was 31.8% (95% confidence interval [CI], 31.4%, 32.2%). Vaccination coverage was significantly higher in the 65-74, 75-79, and 80+ year age groups (35.9%, 37.7%, and 34.3%, respectively) compared to adults 60-64 and 50-59 years (2% and 5.9%, respectively).
When broken down by ethnicity, compared to non-Hispanic whites (35.4%), vaccination coverage among adults 60 years and older was lower in non-Hispanic blacks (16%), Hispanics (16.7%) and American Indians and Alaska Natives (27.2%); rates for Asians (30.2%) were similar.
Significantly higher vaccination coverage was reported among female adults with higher education, higher reported income, currently not in the workforce, living in the Midwest or West, with medical insurance coverage, a primary healthcare provider, and a yearly routine checkup. Participants who reported widowed, divorced, separated, or never married, unemployed, or those living in the South had significantly lower rates of vaccination coverage.
“Shingles vaccination coverage [rates]…indicate that a majority of states reached the Healthy People 2020 target of 30% coverage among adults aged ≥60 years,” the researchers wrote, “although a large majority of Americans have not received the shingles vaccine.”
Dr Lu and colleagues note that compared to the pneumococcal polysaccharide vaccination, shingles vaccination coverage rates are slower. Several factors may contribute to this, including shortages of the herpes zoster vaccine and a lack of vaccine promotion, high vaccine cost for providers, and “stringent storage and handling requirements” that prevent physicians from stocking the vaccine. Additionally, Medicare Part D billing challenges and out of pocket expenses for beneficiaries have contributed to low vaccination rates.
Additional challenges exist due to low patient awareness of the existence of the shingles vaccine. “In 2015, 73.4% of the target population reported awareness of the shingles vaccine,” wrote Dr Lu and colleagues, referencing unpublished data from the CDC Immunization Services Division. “Compared with the shingles vaccine, in 2015, a total of 86.6% of adults ≥65 years reported awareness of the pneumococcal vaccine.”
Dr Lu and colleagues suggest the removal of financial barriers to providers and patients, as well as pharmacy interventions, educational campaigns, reminder/recall systems, and the linking of shingles vaccinations to other vaccine delivery (such as patients’ yearly influenza vaccinations) as plausible methods to increase shingles vaccination coverage on both the national and state level.
“Use of zoster vaccine can significantly reduce morbidity caused by shingles among adults aged ≥60 years. If all eligible adults aged ≥60 years are vaccinated in accordance with [CDC Advisory Committee on Immunization Practices] recommendations, the vaccine could prevent a quarter of a million cases of shingles annually,” the researchers concluded.
- Vaccination coverage was self-reported, and may be subject to recall bias.
- Dr Lu and colleagues were not able to determine age-specific vaccine uptake, since the BRFSS did not collect participants’ time of vaccination.
Disclosures: The authors report no financial disclosures.
- Lu P-j, O’Halloran A, Williams WW, Harpaz R. National and state-specific shingles vaccination among adults aged ≥60 years. Am J Prev Med. 2016. doi: 10.1016/j.ampre.2016.08.031