Journal Article

More Effort Needed For Herpes Zoster Vaccinations

With better HIV treatment, the frequency of Herpes Zoster (HZ) in older adults with HIV has dropped but is still at least two to three times higher than in persons uninfected with HIV. Also, this subgroup is still vulnerable for complications when infected with HZ. So, many clinicians recommend use of the vaccine in HIV-positive adults 50 and older with an undetectable viral load and a CD4 count over 200. A study at 6 sites was implemented to determine the level of vaccine use at baseline and the effect of two regimens for improvement. One protocol included the notification of staff about patient eligibility, and the second added an order for vaccine to be placed in the chart of the eligible patient. At one site before the intervention 21.3% had received the vaccine. An additional 8.3% received the vaccine after the first notificationand 17.8% after the second approach for a total of 53.2%. One reason for noncompliance was the lack of specific published guidelines for use of the HZ vaccine in older adults with HIV. Recently a new HZ vaccine has become available that does not include live attenuated virus, and this alternative may provide a possible advantage for recommendations. Also, a significant problem has been the variation in insurance coverage for the vaccine, which can be a major deterrent. This report provides evidence of strategies for improving vaccine compliance, but it will be necessary to address the other major problems for wider coverage to be successful.

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