Another Underused Vaccine

The June, 2014 issue of Treatment Guidelines from The Medical Letter will be on Adult Immunization. A little less than a year ago, I blogged on underuse of HPV vaccine. But there is another vaccine, recommended for use at the far end of the adult age spectrum, that has been neglected even more, and that is the live-attenuated vaccine (Zostavax) that protects against herpes zoster and postherpetic neuralgia. In spite of study after study, in the US, Canada, the UK, the Netherlands, etc. showing that the vaccine is cost-effective, Medicare does not offer it as a benefit (except in Part D).

So, as a reminder, a single dose of Zostavax is recommended for all immunocompetent adults >60 years old. It costs $165.70, according to the CDC Vaccine Price list, and many private insurance plans do offer it as a benefit, minus deductibles and co-pays, of course. Local reactions to the vaccine are generally mild, and transmission from vaccine recipients to other susceptible persons has not been reported. The main question about zoster vaccine is about the duration of its effectiveness, which wanes over time, but appears to be at least 5 years and probably longer for many patients.

The current labeling specifies a 4-week interval between Zostavax and PPSV23 pneumococcal vaccine, which is also recommended for seniors, but the CDC and ACIP are now promoting administration of both during the same office visit. There is no evidence of risk in doing so; one study found a lower antibody response to the zoster vaccine when pneumococcal vaccine was given at the same time, but others did not.

More information on VZV, PPSV23, HPV, and the other vaccines recommended for use in adults is available in our upcoming Treatment Guidelines issue. Watch for it.

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  1. Janis Eiler MD says:

    Do you have any information or experience on use of Zostavax in patients under age 50? I have a patient in her 40s who had a bone marrow transplant for breast cancer a dozen years ago and who appears to be cured, and her oncologist told her to get Zostavax. The pharmacy won’t administer it because the labeling indicates it is for persons over 50 only.

  2. Bruce Wells says:

    Excellent comment and much needed. More practical literature like this is needed.

  3. I. Pagnotta MD says:

    Is it necessary to get serologic confirmation of chicken pox before administering shingles vaccine?

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