Shingles vaccine safe but not widely used

June 16, 2010

Dr. Michael Simberkoff administers the shingles vaccine to Veteran Marco Antonio at the VA New York Harbor Healthcare System. (Photo by Lamel Hinton)

A vaccine to prevent shingles—a painful nerve and skin infection that mainly affects older adults—is safe over the long term, according to a report in the May 4 Annals of Internal Medicine. The findings are based on data from a nationwide study conducted by VA and the National Institutes of Health from 1998 to 2004. However, other research shows the vaccine, made by Merck and sold as Zostavax, is not yet being used widely in VA or by U.S. health care providers in general.

In 2005, VA and NIH researchers reported in the New England Journal of Medicine that the vaccine cut the incidence of shingles, also known as herpes zoster, by more than 50 percent and dramatically limited its severity and complications. The vaccine was well-tolerated in the trial, with the most common adverse side effect being short-term swelling or irritation at the injection site.

The new Annals report is based on an additional three years of follow-up on the nearly 39,000 men and women who took part in the trial. The researchers also collected more extensive details on possible side effects from a subgroup of more than 6,000 patients.

According to lead author Michael Simberkoff, MD, of the VA New York Harbor Healthcare System, the new analysis "confirms and expands the safety profile of the herpes zoster vaccine that was originally reported in 2005."

The study found that serious adverse events, such as hospitalizations, occurred in only 1.4 percent of participants, and were no more common in the vaccine group than in those who received a placebo injection. Minor side effects such as swelling and redness were more common in the vaccine group (48 percent) than in the placebo group (16 percent), and were more common in people in their 60s than in participants who were older than 70. (Everyone in the trial was over age 60.)

Shingles rates rising despite availability of vaccine

Despite the vaccine's reported efficacy and safety, though, it is not yet being widely used, either in VA or elsewhere. Fewer than 10 percent of eligible U.S. adults are getting the vaccine, according to published reports. Moreover, a recent study appearing in Clinical Infectious Diseases found an increasing incidence of shingles among Veterans: about five cases of shingles per 1,000 VA patients in 2007, versus about three episodes per 1,000 patients in 2000. David Rimland, MD, chief of infectious diseases at the Atlanta VA Medical Center and lead author on the study, says the incidence has since risen to about six cases per 1,000 Veterans in 2009.

Additional efforts in works to promote vaccine

Both Rimland and Simberkoff say the vaccine could help stem the trend if it were promoted more effectively to patients and physicians. "The herpes zoster vaccine is not being used as widely as it could or should be," in or outside VA, says Simberkoff. "We must improve education about this and other adult vaccines in the medical profession and among consumers— the older patient population."

A study that appeared along with Simberkoff's article in the May 4 Annals of Internal Medicine found that outside VA, barriers to the vaccine's use include issues relating to cost and reimbursement, and lack of knowledge about the vaccine on the part of physicians.

Rimland confirmed that while cost is generally not an issue for VA patients, storage of the vaccine—it has to be kept frozen—can be an obstacle at smaller VA clinics not equipped with freezers. He says that in his region, a group is working to address the issue. He adds that across VA, "There has not been an aggressive push for the vaccine as we have had for the influenza vaccine."

Linda Kinsinger, MD, MPH, chief consultant for preventive medicine for VA and director of the agency's National Center for Health Promotion and Disease Prevention, noted that the vaccine is covered in a set of "Guidance Statements" that her program is preparing to issue for VA clinicians.

The guidance will be consistent with that of the Advisory Committee on Immunization Practices, a body appointed by the Department of Health and Human Services, and will include links to staff and patient-education tools. Says Kinsinger, "We hope that this guidance will increase the uptake of [the shingles vaccine] within VA facilities."

This article originally appeared in the June 2010 issue of VA Research Currents.