February 25, 2019

Dermatologists have not traditionally played a systematic role in recommending and administering immunizations.

Widespread encouragement among dermatologists and other physicians to regularly recommend and/or offer the herpes zoster (HZ) vaccine to their patients is key to prevention of the disease.

Approved in 2017, the recombinant HZ vaccine (HZ/su) was designed to prevent HZ infection and associated sequelae with greater efficacy and safety than the zoster vaccine live (ZVL) precursor vaccine. A review and an update on the prevention of HZ infection, along with the current role played by dermatologists in fostering administration of the vaccine, was published in the Journal of Drugs in Dermatology.

Although dermatologists encounter patients with HZ infection regularly, recommendation of vaccination against the disease has been minimal over the past years, resulting in low rates of overall patient awareness and use of HZ vaccines. As the HZ/su vaccine has several improvements over the live vaccine, dermatologists nonetheless still encounter impediments to vaccine recommendation and administration, including concerns about efficacy, limited availability, and complex cost and reimbursement for vaccine administration. Moreover, dermatologists have not traditionally played a systematic role in recommending and administering immunizations.

The investigators conducted a review of the literature to study the current role played by dermatologists and other physicians in HZ prevention, the safety and efficacy of the HZ/su vaccine, potential barriers to its recommendation by dermatologists, and the practicality of administering HZ/su vaccines in dermatology offices. The primary search database used in the analysis was PubMed/Medline.

The HZ/su vaccine costs approximately $290 for 2 doses, which is more expensive than the ZVL vaccine which costs approximately $230. Although the vaccine is more expensive than the ZVL vaccine, because of the efficacy that has been demonstrated by the HZ/su vaccine in randomized controlled trials, the HZ/su vaccine has been deemed more cost-effective compared with the ZVL vaccine or nonimmunization according to the costs of HZ treatment and the management of possible sequelae.

The investigators concluded that dermatologists are in a prime position to make the HZ/su vaccine more available to their patients. If the HZ/su vaccine, or a means of receiving the vaccine, is offered regularly at dermatology appointments, not only will dermatologists become accustomed to recommending the vaccine, but patients will also be more likely to obtain the immunization at the time it is recommended. Additional options for increasing HZ vaccine use include educational training for healthcare providers, partnering with the manufacturers of the vaccine, partnering with pharmacies, and widespread patient education.

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Reference

Felix KA, Ediale CE, McMichael AJ. Update in herpes zoster prevention and the role of dermatologists. J Drugs Dermatol. 2019;18(1):18-22.