Herpes zoster vaccine administration suboptimal

Physicians most frequently reported financial concerns as top barrier to vaccination.

Advocating increased reimbursement for herpes zoster vaccine administration, promoting provider knowledge regarding available simplified claims processes and increasing clinician awareness of appropriate vaccine delivery methods were among strategies discussed to improve herpes zoster vaccine uptake at the Advisory Committee on Immunization Practices meeting.

In 2007, herpes zoster (HZ) vaccine uptake rates among the target population of adults aged older than 60 years were low at 1.9%, data from the CDC's National Immunization Survey – Adult 2007 indicated.

“I want to emphasize how important it is to vaccinate even the oldest of the old because they are the ones who disproportionately bear longer durations and more severe disease. They also often have fewer resources, they’re more frail, they’re less able to tolerate the disease and they’re not able to tolerate the medications that are used to treat post herpetic neuralgia,” Rafael Harpaz, MD, MPH, of the CDC said during an update on HZ vaccine implementation.

“This is the most expensive vaccine for adults aged 60 and over,” Allison Kempe, MD, MPH, professor of pediatrics at the University of Colorado, Denver, reminded ACIP members. The average wholesale price of the vaccine is about $194 and retail prices can easily surpass $200.

Furthermore, 13% of the 598 family medicine physicians and general internists surveyed by Kempe and colleagues knew that HZ vaccine is reimbursed through Medicare Part D; 48% were completely unaware of reimbursement procedures for the vaccine.

Knowledge about various websites designed to simplify the reimbursement process by enabling electronic claims submissions was also poor, with 7% of respondents aware that such sites existed and only 1% reporting membership.

Additionally, “brown bagging,” a vaccine administration method in which clinicians refer patients to a pharmacy to purchase the vaccine and then administer the vaccine in office, was used by 39% of respondents. This method is discouraged as HZ vaccine requires freezer storage, and such handling can compromise the vaccine’s efficacy.

“Approaches to optimizing HZ vaccine delivery should include education regarding appropriate delivery methods, and solutions to financial and billing problems,” Kempe said. – by Nicole Blazek

I've been struck by the knowledge among seniors of this vaccine. Overwhelmingly most of my patients have heard about it; overwhelmingly most of them want it. But I've had to use the term 'economic deferral' 50% to 70% of time in my clinical notes. This is a vaccine that I'm not providing to patients because they cannot afford it, and I'm seeing more and more of my patients, with tapped resources over the last few years and looking at the economy, that cannot afford this. I think this is such a crucial issue right now because this is the one vaccine that I provide in a very inequitable manner.

– Jonathan Temte, MD, PhD

Associate Professor of Family Medicine, University of Wisconsin
Advisory Committee on Immunization Practices

For more information:

Harpaz R, Kempe A. Update: Herpes Zoster (Shingles) Vaccine. Presented at: the ACIP meeting; Feb. 25-26, 2009; Atlanta.