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Rates of hospitalisation for herpes zoster may warrant vaccinating Indigenous Australians under 70

Meru Sheel, Frank H Beard, Aditi Dey, Kristine Macartney and Peter B McIntyre
Med J Aust 2017; 207 (9): 395-396. || doi: 10.5694/mja16.01468

Herpes zoster (HZ) is caused by reactivation of latent varicella zoster virus infection. The most common complication of HZ is post-herpetic neuralgia (PHN), which is often debilitating and refractory to treatment.1 The incidence of both HZ and PHN increases markedly with age.2 In November 2016, a vaccine for HZ was included in Australia’s National Immunisation Program (NIP) for all people aged 70, together with a 5-year catch-up program for those aged 71–79 years.3 The vaccine is cost-effective for people aged 70–79, but is registered for vaccinating people from age 50.3

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  • Meru Sheel1,2
  • Frank H Beard1,3
  • Aditi Dey1,3
  • Kristine Macartney1,3
  • Peter B McIntyre1,3

  • 1 National Centre for Immunisation Research and Surveillance, the Children's Hospital at Westmead, Sydney, NSW
  • 2 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
  • 3 University of Sydney, Sydney, NSW


Acknowledgements: 

This work was supported by the National Centre for Immunisation Research and Surveillance. Meru Sheel is a scholar in the Master of Philosophy in Applied Epidemiology program at the Australian National University.

Competing interests:

No relevant disclosures.

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access_time 02:47, 6 December 2017
David Corbet, Jenny Royle

The Research Letter by Sheel et al (1) states that “Concerns have been raised by clinicians in Aboriginal and Torres Strait Islander health care that the National Immunisation Program age criterion does not take into account the special circumstances of Indigenous Australians”
 
As clinicians working in Aboriginal and Torres Strait Islander health care, who have written about this topic (2), we felt it is important to raise the following issues.

Zoster vaccine is registered (3) from 50 years of age, but is unfunded until 70. It is unaffordable to many, costing around $200. Due to a lower life-expectancy, many Aboriginal and Torres Strait Islander people will die before they are able to access the funded vaccination. Life expectancy for a male Aboriginal and Torres Strait Islander child born in 2012 is 69.1 years, and 73.7 years for females (4).

The article demonstrates the increased burden of zoster disease requiring hospitalisation in the 50-59 and 60-69 year age groups (1).

The zoster vaccine prevents a significant number of cases of shingles, reduces the severity of many cases, and reduces post herpetic neuralgia. Shingles is a preventable condition occurring in Aboriginal and Torres Strait Islander populations but we are denying many the opportunity to benefit from the vaccine which is not consistent with ‘Close the Gap’ strategies.

We welcome these research findings and support the call to re-evaluate the age criteria for zoster vaccination for Aboriginal and Torres Strait Islander peoples.

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1. Rates of hospitalisation for herpes zoster may warrant vaccinating Indigenous Australians under 70
Meru Sheel, Frank H Beard, Aditi Dey, Kristine Macartney and Peter B McIntyre
Med J Aust 2017; 207 (9): 395-396. || doi: 10.5694/mja16.01468

2. Calls for shingles vaccine program to cater for Aboriginal and Torres Strait Islander people. David Corbet and Jenny Royle, Croakey Health Blog, published Jan 04, 2017.
https://croakey.org/calls-for-shingles-vaccine-program-to-cater-for-aboriginal-and-torres-strait-islander-people/

3. NCIRS Fact Sheet: August 2017. Accessed online 22/11/17.
 http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/zoster-vaccine-fact-sheet.pdf

4. Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 2001 to 2026. Australian Bureau of Statistics. LATEST ISSUE Released at 11:30 AM (CANBERRA TIME) 30/04/2014. Accessed online 22/11/17. http://www.abs.gov.au/ausstats/abs@.nsf/Products/6694405ADBF2B03BCA257CC9001439A6?opendocument

Competing Interests: No relevant disclosures.

Dr David Corbet
Surfcoast Medical Centre

Dr Jenny Royle
NEST Family Clinic

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