Herpes zoster vaccination in the elderly subjects: improving awareness and uptake

Herpes zoster (HZ) is a common disease in adults and older subjects solely related to the reactivation of latent varicella zoster virus in ganglia. The incidence of the disease increases with aging and the decline of varicella zoster virus-specific cell-mediated immunity. HZ has a significant impact on the quality of life of subjects during the acute phase. Besides, pain can persist even for a long time becoming chronic. The chronic pain following HZ is called postherpetic neuralgia, and it is a debilitating long-lasting condition, characterized by metameric pain, allodynia, and hyperalgesia. Therapeutic options against HZ and postherpetic neuralgia are often suboptimal and the impact of the disease and its complications on daily living activities is significant, especially in older subjects. Nowadays, a preventive approach to the disease is possible; as a matter of fact, a high-antigen content live vaccine is available. This vaccine has a good profile in terms of immunogenicity, efficacy, effectiveness, and safety and its use may prevent both HZ and postherpetic neuralgia. Nevertheless, the evaluation of the issues raised in countries that introduced this immunization show that both provider and patient barriers could have prevented a more robust uptake of HZ vaccination. In the USA, HZ immunization storage was expensive, reimbursement was cumbersome, and supply shortages may have limited promotion by the interests of the manufacturer and provider. The doctors did not actively recommend HZ vaccination; on the other hand, subjects were mostly unaware of the HZ vaccine. Several demographic factors, including sex and educational level, could have negatively affected the coverage rates; besides, the clinicians who treat adults focus less on vaccination than those taking care of children. On the other hand, when health care profession- als undertook every effort to maximize the uptake of the shingles vaccine (eg, in the UK), the vaccine coverage rate increased very quickly.