Abstract
ABSTRACT Herpes zoster (shingles) is a painful condition resulting from reactivation of latent varicella zoster virus (VZV). The Australian National Shingles Vaccination Program (commenced November 2016) provides free herpes zoster vaccination for eligible adults aged 70 years, with a 5-year catch-up program (until October 2021) for adults aged 71–79 years. Patterns and impact of the program were evaluated by analysis of vaccine distribution and delivery data and specific antiviral prescription data from the Pharmaceutical Benefits Scheme. During the first 2 years, uptake of funded live attenuated shingles vaccine ZOSTAVAX® (Zoster Virus Vaccine Live; ZVL) was high across the ongoing and catch-up programs. Before program implementation (2006–2016), herpes zoster coded antiviral prescription rates increased by 2.2% per year (95% CI: 1.5, 2.9) in the 70–79 years age group. In the two years since program launch, herpes zoster antiviral prescription rates declined substantially in this age group, by an average of 13.6% per year (95% CI: 1.5, 24.2). These results indicate that the National Shingles Vaccination Program has been highly successful in vaccinating a considerable proportion of Australian adults aged 70–79 years against herpes zoster and suggest that vaccine uptake was associated with decreased incidence of herpes zoster.
Highlights
Herpes zoster is a painful condition usually characterized by an erythematous papulovesicular rash in a unilateral dermatomal distribution in immunocompetent individuals.[1,2] Herpes zoster results from reactivation of latent neuronal varicella zoster virus (VZV).[1,2] The incidence of herpes zoster increases with age owing to a progressive decline in virus-specific cell-mediated immunity, leading to VZV reactivation.[1,2] In Australia, according to data from the BEACH (Bettering the Evaluation And Care of Health) database, there were an estimated 5.6 cases per 1,000 population per year over the period 2006–2013, with an estimated 13.7, 15.3, and 19.9 cases per 1,000 population in the 60–69 years, 70–79 years, and ≥80 years age groups, respectively.[3]
Between April 2015 and September 2016, before commencement of the National Shingles Vaccination Program, there were between one and 18 ZVL vaccinations recorded per month (Figure 1(a)), which was indicative of very low use of the vaccine before commencement of the funded program
In the ≥80 years age group, which includes participants aged 80–82 years who would have been eligible for vaccination at the start of the National Shingles Vaccination Program, rates of antiviral prescriptions for herpes zoster decreased to a lesser extent than that observed in the 70–79 years age group
Summary
Herpes zoster (shingles) is a painful condition usually characterized by an erythematous papulovesicular rash in a unilateral dermatomal distribution in immunocompetent individuals.[1,2] Herpes zoster results from reactivation of latent neuronal varicella zoster virus (VZV).[1,2] The incidence of herpes zoster increases with age owing to a progressive decline in virus-specific cell-mediated immunity, leading to VZV reactivation.[1,2] In Australia, according to data from the BEACH (Bettering the Evaluation And Care of Health) database, there were an estimated 5.6 cases per 1,000 population per year (all ages) over the period 2006–2013, with an estimated 13.7, 15.3, and 19.9 cases per 1,000 population in the 60–69 years, 70–79 years, and ≥80 years age groups, respectively.[3]. Herpes zoster (shingles) is a painful condition usually characterized by an erythematous papulovesicular rash in a unilateral dermatomal distribution in immunocompetent individuals.[1,2]. The incidence of herpes zoster increases with age owing to a progressive decline in virus-specific cell-mediated immunity, leading to VZV reactivation.[1,2]. Older individuals are more likely to develop complications from herpes zoster, including the debilitating condition of postherpetic neuralgia (PHN; defined as pain lasting more than 3 months after the onset of rash).[1,2]. One in five patients aged over 50 years with herpes zoster will continue to report pain 6 months after the onset of rash despite adequate antiviral therapy.[4]. The economic burden of herpes zoster and PHN is high in Australia, with estimated annual costs to the healthcare system of approximately AUD 33 million in 2006 for people aged 50 years and older.[9]
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