Low Rates of Vaccination for Herpes Zoster in Older People Living With HIV

Abstract

Herpes zoster (HZ) occurs at a higher age-specific rate in people living with HIV (PLWH) than in the general population. We implemented a quality improvement study to assess herpes zoster vaccine (HZV) usage among PLWH, assess HZV usage after additional reminders/prompts, and identify barriers to HZV among older PLWH. HZV rates in PLWH were determined in six institutions with varying payment structures. For the intervention, Part 1, PLWH eligible for HZV at the University of Colorado were identified, and providers were notified of patient eligibility. In Part 2, in addition to provider notification, an order for HZV was placed in the patient's chart before a clinic appointment. HZ vaccination rates ranged from 1.5% to 42.4% at six sites. Before the intervention, 21.3% of eligible University of Colorado patients had received HZV. An additional 8.3% received HZV with Part 1 and 17.8% with Part 2 interventions. At completion, a total of 53.2% of eligible patients had received HZV through routine clinical care or the interventions. Insurance coverage concern was cited as a common reason for not receiving HZV. Minor adverse reactions occurred in 26.7% patients and did not require medical care. HZV coverage was low at a majority of sites. Clinical reminders with links to vaccination orders or preplaced vaccination orders led to improved HZV coverage in our clinic, but published guidelines for use of HZV in PLWH and improvement in logistic or insurance barriers to HZV receipt are paramount to improved HZV coverage.

Herpes Zoster Rates Continue to Decline in People Living With Human Immunodeficiency Virus but Remain Higher Than Rates Reported in the General US Population

“…Despite these recommendations, vaccination rates are low. The NHS rate of 10% is in keeping with recent reports that suggest rates of between 1.5% and 42.4% in PLWH [12]. Vaccination remains a proven way for HZ prevention, and the advent of RZV should reduce concerns associated with LAHZV.…”

A review of factors influencing vaccination policies and programs for older adults globally

“…An additional 17.3% were vaccinated after prompts from the individuals electronic medical record (EMR). 28 Persons ≥65 years of age consulting with providers who received pneumococcal vaccination EMR reminders were 2.61 times (95% CI 1.18–6.10) more likely to be vaccinated than those in the control group (20% vs 8.7%). 29 Another study found that in three out of four groups studied, passive EMR health maintenance notifications (alerts staff when patient records are reviewed with the patient in the room) were more effective than best practice alerts (follow-up pop-up message) or workflow redesign in promoting pneumococcal vaccination series completion among immunocompetent adults ≥65 years of age.…”

O conhecimento dos profissionais de saúde sobre vacinação de pessoas vivendo com HIV – uma revisão integrativa

“…No Brasil, a vacina contra herpes zoster é uma vacina de vírus vivo atenuado, recomendada para PVHIV com idade superior a 50 anos, sem sinais e sintomas de imunodepressão, porém, ela não é oferecida pelo Programa Nacional de Imunizações (PNI) e por isso está disponível apenas nas clínicas de vacinação da rede privada, o que pode levar a uma baixa cobertura vacinal contra as doenças causadas pelo herpes zoster 28,30 .…”