Letters
Infectious diseases
Volume 193 - Issue 8

Evidence of increasing frequency of herpes zoster management in Australian general practice since the introduction of a varicella vaccine

Authors:  Kristina A Grant, Kylie S Carville and Heath A Kelly

Med J Aust 2010; 193 (8): 483. || doi: 10.5694/j.1326-5377.2010.tb04009.x
Published online: 18 October 2010
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To the Editor: Nelson and colleagues1 referred to the limited community data from the Melbourne Medical Deputising Service (MMDS) that was analysed by Carville et al.2 MMDS consultations also represent general practice consultations, although the majority of MMDS consultations occur after hours. We can now provide an update on MMDS consultations from January 1998 to June 2010, stratified by age.

De-identified data were extracted from the MMDS database for diagnoses that included the terms “chicken pox” or “varicella” and “shingles” or “zoster”, and patient age. Using the total consultations as the denominator, we calculated the crude and age-specific rates of varicella (chickenpox) and herpes zoster (HZ [shingles]) per 1000 consultations by week, and present the results here by year.

These updated data support the conclusions reached by both groups of researchers that there has been a decrease in varicella cases and a rise in HZ cases in Australian general practice consultations since the introduction of a varicella vaccine in 2000. We had previously shown a decrease in hospitalisations and MMDS consultations for varicella and an uncertain effect on HZ up to 2007 after the introduction of varicella vaccine.2

The overall rate of varicella-related MMDS consultations continued to decline from 2007 to 2010, with an annual average rate of 3.3/1000 consultations in 2000 decreasing to 1.5/1000 consultations in 2007 (P < 0.001, 2000–2007) and to 1.0/1000 consultations for the first half of 2010 (P = 0.043, 2007–2010). Decreasing rates of varicella-related consultation were seen in all age groups, although an apparent increase in the consultation rate for children aged less than 5 years in 2010 might be explained by a summer peak in varicella infection and incomplete annual data (Box 1).3

The trend in HZ-related MMDS consultations showed an increase in the annual average rate from 1.7/1000 consultations in 2000 to 2.7/1000 consultations in 2007 (P < 0.001, 2000–2007) and to 3.4/1000 consultations for the first half of 2010 (P = 0.020, 2007–2010). There was a substantial increase in the HZ-related consultation rates for people aged 70–79 years and 80+ years (Box 2). Our updated data support the recommendation for adding vaccination against HZ to the vaccine schedule for older Australians,1 although the optimal age at which this should occur remains to be determined.

1 Varicella (chickenpox)-related consultation rates, by age group, 1998 to June 2010*

* Data from the Melbourne Medical Deputising Service database.

2 Herpes zoster (HZ [shingles])-related consultation rates, by age group, 1998 to June 2010*

* Data from the Melbourne Medical Deputising Service database.

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