GP Recommendation Increases Acceptance of Shingles Vaccine

Pam Harrison

April 14, 2014

CAPE TOWN, South Africa — A recommendation from a general practitioner (GP) for vaccination against herpes zoster, also known as shingles, is a key factor in motivating people to get immunized, new research shows.

"We did this study prior to the vaccine being available, so people didn't know much about it," said John Litt, MD, associate professor of general practice at Flinders University in Adelaide, South Australia.

When patients were asked how likely they were to get the shingles vaccine, about half said they were likely to get it, he reported.

However, people were over 20 times more likely to say they would get the vaccine if it was recommended by a GP than if it was not. After adjustment for confounding variables, patients were still over 10 times more likely to indicate they would get the shingles vaccine if it was recommended by a GP, he explained.

A recommendation "gives patients a personal element they can relate to, rather than having some authority tell them that they have to get a vaccine," Dr. Litt told Medscape Medical News.

The study results were presented here at the 16th International Congress on Infectious Diseases.

Investigators asked a random sample of 50 GPs in 2 urban areas in South Australia to identify beliefs about shingles and its complications and factors they felt might influence the uptake of the herpes zoster vaccine.

They then interviewed a random sample of patients from each of the GPs. The 1330 patients were 60 to 85 years of age and made at least 1 visit to their GP in the previous 2 years.

About half of the GPs said they were "very likely" to recommend the shingles vaccine to their patients.

More than 80% of the patients interviewed knew of someone who had had shingles, and half indicated that if they were to get shingles, it would have a major impact on their life.

Just more than half of the patients interviewed indicated that they would get the shingles vaccine no matter what, but 89% said they would get the vaccine if their GP recommended it.

After adjustment for other variables, "GP recommendation remained the strongest predictor of patient intention to get the vaccine," the investigators report.

Preventing Postherpetic Neuralgia

People's understanding of shingles is somewhat limited, Dr. Litt told Medscape Medical News.

"They don't recognize that you don't catch singles — you've already got it," he explained. In fact, 95% of the general population has antibodies to the varicella virus, and they are at risk for zoster reactivation decades after having had chicken pox because cell-mediated immunity wanes with age.

"We need to better understand how to boost people's immune systems, but at the moment, we have no alternative except vaccines," said Dr. Litt.

Antiviral therapy can shorten the severity and duration of an acute zoster episode, provided it is introduced within 72 hours of rash onset. However, it does not prevent postherpetic neuralgia, the incidence of which increases with age.

"Postherpetic neuralgia is a real game changer," said Dr. Litt. "The only way we are going to do something about it is to prevent it, which we can with this vaccine."

The Shingles Prevention Study, involving more than 38,000 adults 60 years and older, showed that the herpes zoster vaccine prevented approximately half of all episodes of acute zoster and approximately two thirds of all episodes of postherpetic neuralgia (N Engl J Med. 2005;352:2271-2284).

Vaccine Decision Making

"This study confirms what we know about the influence of healthcare providers on vaccine decision-making," said Douglas Opel, MD, assistant professor of pediatrics at the University of Washington School of Medicine in Seattle.

"We know healthcare providers are very influential — perhaps the most influential — people in helping parents make a decision about vaccination. Even parents who are skeptical or hesitant about vaccines see their child's provider as an important person in terms of deciding to go ahead with a vaccine," Dr. Opel told Medscape Medical News.

He added that this is even true with adolescent vaccines such as the human papillomavirus (HPV) vaccine.

In fact, not only is a recommendation from a healthcare provider to get the HPV vaccine highly influential in terms of whether an adolescent will get it or not, the strength of that recommendation is an important determinant in decision making as well, said Dr. Opel.

This study was funded by MSD. Dr. Litt and Dr. Opel have disclosed no relevant financial relationships.

16th International Congress on Infectious Diseases (ICID): Abstract 63/015. Presented April 5, 2014.


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