1. Arch Dermatol. 2010 May;146(5):569-70.

Permanent localized hair repigmentation following herpes zoster infection.

Adiga GU, Rehman KL, Wiernik PH.

PMID: 20479318 [PubMed - in process]


2. Curr Top Microbiol Immunol. 2010 May 7. [Epub ahead of print]

VZV T Cell-Mediated Immunity.

Weinberg A, Levin MJ.

University of Colorado Denver, Research Complex 2, Mail Stop 8604, 12700 E. 19th 
Ave., Aurora, CO, 80045, USA, Adriana.Weinberg@ucdenver.edu.

Primary varicella-zoster virus (VZV) infection (varicella) induces VZV-specific
antibody and VZV-specific T cell-mediated immunity. T cell-mediated immunity,
which is detected within 1-2 weeks after appearance of rash, and consists of both
CD4 and CD8 effector and memory T cells, is essential for recovery from
varicella. Administration of a varicella vaccine also generates VZV-specific
humoral and cellular immune responses. The memory cell responses that develop
during varicella or after vaccination contribute to protection following
re-exposure to VZV. These responses are subsequently boosted either by endogenous
re-exposure (silent reactivation of latent virus) or exogenous re-exposure
(environmental). VZV-specific T cell-mediated immunity is also necessary to
maintain latent VZV in a subclinical state in sensory ganglia. When these
responses decline, as occurs with aging or iatrogenic immune suppression,
reactivation of VZV leads to herpes zoster. Similarly, the magnitude of these
responses early after the onset of herpes zoster correlates with the extent of
zoster-associated pain. These essential immune responses are boosted by the VZV
vaccine developed to prevent herpes zoster.

PMID: 20473790 [PubMed - as supplied by publisher]


3. Infect Dis Clin North Am. 2010 Jun;24(2):373-93.

Herpes viruses in transplant recipients: HSV, VZV, human herpes viruses, and EBV.

Shiley K, Blumberg E.

Division of Infectious Diseases, Hospital of the University of Pennsylvania, 3rd 
Floor Silverstein Pavilion, Suite E, 3400 Spruce Street, Philadelphia, PA 19104, 
USA. shileyk@uphs.upenn.edu

The herpes viruses are responsible for a wide range of diseases in patients
following transplant, resulting from direct viral effects and indirect effects,
including tumor promotion. Effective treatments and prophylaxis exist for the
neurotropic herpes viruses HSV-1, HSV-2, varicella zoster virus, and possibly
HHV-6. Antivirals seem to be less effective at prevention of the tumor-promoting 
effects of Epstein-Barr virus and HHV-8. Reduction in immunosuppression is the
cornerstone to treatment of many diseases associated with herpes virus
infections. Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 20466275 [PubMed - in process]


4. Int J Dermatol. 2010 Feb;49(2):234-5.

Wolf's isotopic response--lichen planus at the site of healed herpes zoster in an
Indian woman.

Ghorpade A.

PMID: 20465656 [PubMed - in process]


5. Int J Dermatol. 2010 Jan;49(1):105-7.

Wolf's isotopic response--furuncles at the site of healed herpes zoster in an
Indian male.

Ghorpade A.

PMID: 20465628 [PubMed - in process]


6. Br J Neurosurg. 2010 Jun;24(3):298-300.

Carotico-cavernous fistula secondary to Varicella zoster?

Amato-Watkins A, St George EJ, Saxena A, Bhattacharya J.

Department of Neurosurgery, Institute of Neurological Sciences, Southern General 
Hospital, Glasgow, United Kingdom.

We describe the case of a previously well, 73-year-old male patient who presented
with a spontaneous high flow, carotico-cavernous fistula, 1 month following an
attack of herpes zoster. We postulate that the zoster virus was the underlying
cause, given the history and time frame between the preceding shingles and the
subsequent development of the fistula. The literature supporting this hypothesis 
is reviewed.

PMID: 20465460 [PubMed - in process]


7. S Afr Med J. 2010 Mar 8;100(3):172-4.

Hutchinson's sign as a marker of ocular involvement in HIV-positive patients with
herpes zoster ophthalmicus.

Van Dyk M, Meyer D.

Stellenbosch University, Tygerberg, W Cape. mariusvandyk@hotmail.com

BACKGROUND: A positive Hutchinson's sign indicates an increased risk of ocular
involvement in herpes zoster ophthalmicus (HZO). We examined the sensitivity of
Hutchinson's sign as an indicator of ocular involvement in a consecutive series
of patients presenting with HZO. METHODS: We conducted a descriptive
observational prospective study of patients > or =18 years old presenting with
HZO and consenting to pre-and post-test counselling and HIV and CD4 testing. A
full ophthalmological examination focused on the extent of ocular involvement,
and the presence of Hutchinson's sign was confirmed by two clinicians. RESULTS:
Thirty-three patients were enrolled; 29 were HIV positive, of whom 18 (62%) had
not been diagnosed with HIV prior to enrollment. Of the 29 HIV-positive patients,
21 (72%) were Hutchinson's sign positive (HSP), all of whom had intra-ocular
involvement (95% confidence interval 88 - 100%). Of the 8 HIV-positive,
Hutchinson's sign-negative (HSN) patients, 4 did and 4 did not display
intra-ocular involvement. Neither the mean CD4 count nor the average age in the
HSP group differed significantly from the HSN group. CONCLUSION: We confirmed
that a Hutchinson's sign- and HIV-positive patient with HZO has a very high
positive predictive value for intra-ocular involvement. Neither age nor CD4 count
had predictive value for ocular involvement. Young adults presenting with HZO
should be suspected of having HIV, and HIV-positive patients with HZO but HSN may
still have ocular involvement. All patients with HZO should be seen by an
ophthalmologist.

PMID: 20459942 [PubMed - in process]


8. BMC Fam Pract. 2010 May 6;11(1):33. [Epub ahead of print]

Epidemiology of Herpes Zoster Infection among Patients Treated in Primary Care
Centres in the Valencian Community (Spain).

Cebrian-Cuenca AM, Diez-Domingo J, Puig-Barbera J, Navarro-Perez J,
Sanmartin-Rodriguez M.

ABSTRACT: BACKGROUND: There is little available data regarding the epidemiology
of herpes zoster (HZ) in Spain. This study's main goal was to estimate the annual
incidence of HZ in the Autonomous Community of Valencia. METHODS: From December
1st 2006 to December 1st 2007 a prospective study was carried out in 24 primary
health care centres that together provide care for a population of 36,030 persons
aged >14 years. We included all adult patients with a clinical diagnosis of HZ
who were seen at these centres during the one-year study period. Demographic
(i.e., age, gender and area of residence) and clinical data were also collected
from these patients. Results: A total of 146 cases of HZ were identified during
the study period. The annual incidence of HZ was 4.1/1,000 individuals >14 years 
of age (95% confidence interval [CI]: 3.4-4.7). Cases of HZ were predominantly
unilateral and most commonly affected women and people living in rural areas. The
most frequently reported symptoms were pain, dysesthesia and itching. A total of 
46% of patients also had underlying illnesses (e.g., chronic diseases and/or
malignancy) and 24% of patients experienced complications, which were mostly
ocular in nature. A total of 91% of patients were treated with antiviral drugs.
The median time from symptom onset to diagnosis was 6.3 days (range: 2.0-8.3).
CONCLUSIONS: Herpes zoster is a common illness in our region (especially in the
older population) that causes a significant clinical burden on primary care
providers.

PMID: 20459608 [PubMed - as supplied by publisher]


9. Arch Neurol. 2010 May;67(5):640-1.

Laser scanning in vivo confocal microscopy demonstrating significant alteration
of human corneal nerves following herpes zoster ophthalmicus.

Patel DV, McGhee CN.

Department of Ophthalmology, University of Auckland, Auckland, New Zealand.

PMID: 20457969 [PubMed - in process]


10. Pain. 2010 May 8. [Epub ahead of print]

Natural history of cutaneous innervation following herpes zoster.

Petersen KL, Rice FL, Farhadi M, Reda H, Rowbotham MC.

Pain Clinical Research Center, Department of Neurology, University of California,
San Francisco, CA, USA.

As part of a comprehensive study of the natural history of herpes zoster (HZ), 57
of 94 subjects in a cohort at elevated risk for post-herpetic neuralgia (PHN)
consented to collection of 3-mm skin punch biopsies from affected, mirror-image, 
and distant control skin at baseline and followup visits. As cutaneous
innervation is reduced in longstanding severe PHN, we tested the hypothesis that 
development of PHN is correlated with severity of initial neural injury and/or a 
failure of neural recovery. Quantitative analysis using single-label PGP9.5
immunofluorescence microscopy showed epidermal profiles were reduced in zoster
skin by approximately 40% at study entry compared to control and mirror skin. The
density of the subepidermal plexus was approximately 15% lower in zoster skin.
Mirror skin was not denervated compared to control skin. Although not significant
at all visits, correlations between epidermal nerve fiber density in HZ skin and 
thermal sensation, allodynia, capsaicin response, and average daily pain all
associated more severe abnormalities with lower epidermal innervation. There was 
limited evidence that the initial neural injury was more severe in the 15
eventual PHN subjects. Overall, pain and pain-related disability resolved the
fastest. Sensory abnormalities and symptom aggravation by focal capsaicin
application showed partial and selective recovery over 6months. In contrast,
cutaneous innervation showed no recovery at all by 6months, conclusive evidence
that resolution of pain and allodynia does not require cutaneous reinnervation. A
much longer period of observation is needed to determine if zoster-affected skin 
is ever reinnervated. Copyright © 2010 International Association for the Study of
Pain. Published by Elsevier B.V. All rights reserved.

PMID: 20457490 [PubMed - as supplied by publisher]


11. Skin Res Technol. 2010 May;16(2):198-201.

Does skin temperature difference as measured by infrared thermography within 6
months of acute herpes zoster infection correlate with pain level?

Han SS, Jung CH, Lee SC, Jung HJ, Kim YH.

Seoul National University Hospital, Seoul, Korea.

BACKGROUND: Changes in the temperature distribution of the skin follows herpes
zoster (HZ). Infrared thermography is a non-invasive, non-ionizing diagnostic
tool that provides information about normal and abnormal functioning of the
sensory and sympathetic nervous systems. This study examined the usefulness of
infrared thermography as a predictor of post-herpetic neuralgia (PHN). METHODS:
Infrared thermography was performed on the affected body regions of 110 patients 
who had been diagnosed with acute HZ. Demographic data collected included age,
gender, time of skin lesions onset, development of PHN, and comorbidities. The
temperature differences between the unaffected and affected dermatome were
calculated. Differences >0.6 degrees C for the mean temperature across the face
and trunk were considered abnormal. RESULTS: The affected side was warmer in 35
patients and cooler in 33 patients than the contralateral side. A patient's age
and disease duration affected treatment outcomes. However, the temperature
differences were not correlated with pain severity, disease duration, allodynia, 
development of PHN, and use of antiviral agents (P>0.05). CONCLUSION: A patient's
age and disease duration are the most important factors predicting PHN
progression, irrespective of thermal findings, and PHN cannot be predicted by
infrared thermal imaging.

PMID: 20456100 [PubMed - in process]


12. HNO. 2010 May;58(5):419-25.

[Idiopathic facial palsy]

[Article in German]

Grosheva M, Beutner D, Volk GF, Wittekindt C, Guntinas-Lichius O.

Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Halschirurgie der
Universitätsklinik Köln, Kerpener Strasse 62, 50937, Köln, Deutschland.
maria.grosheva@uk-koeln.de

Idiopathic facial palsy (IFP), or Bell's palsy, is an acute peripheral unilateral
paresis of the facial nerve with an abrupt onset of unknown origin. Primary
infection or reactivation of the Herpes simplex virus is suggested as a possible 
mechanism in some but not all patients. Since IFP is a diagnosis of exclusion,
all other causes, especially other neurological diseases or Herpes zoster
reactivation need to be excluded, as does Lyme disease in children and endemic
areas. If recovery or defective healing has not taken place within 6-12 months,
it is mandatory to exclude malignant disease. Severity of the paresis and
electromyography are to date the best prognostic markers for defective healing.
Steroid application is the only evidence-based therapy to date with recovery
rates >90%. The spontaneous recovery rate is about 80%. There is a lack of well
defined diagnostic procedures to detect those patients who will recover
spontaneously. On the other hand, patients with severe complete paresis might
profit from additional antiviral drugs. There is an urgent need for further
clinical trials in patients with severe IFP.

PMID: 20454880 [PubMed - in process]


13. Medicine (Baltimore). 2010 May;89(3):166-75.

Infectious and non-infectious neurologic complications in heart transplant
recipients.

Muñoz P, Valerio M, Palomo J, Fernández-Yáñez J, Fernández-Cruz A, Guinea J,
Bouza E.

Department of Clinical Microbiology and Infectious Diseases, Hospital General
Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain.
pmunoz@micro.hggm.es

Neurologic complications are important causes of morbidity and mortality in heart
transplant (HT) recipients. New immunomodulating agents have improved survival
rates, although some have been associated with a high rate of neurologic
complications (infectious and non-infectious). We conducted this study to analyze
the frequency of these complications, before and after the use of daclizumab
induction therapy. We reviewed all neurologic complications in our HT cohort,
comparing infectious with non-infectious complications over 2 periods of time in 
which different induction therapies were used (316 patients with OKT3 or
antithymocyte globulin from 1988 to 2002, and 68 patients with daclizumab from
2003 to 2006). Neurologic complications were found in 75/384 patients (19.5%)
with a total of 78 episodes. Non-infectious complications accounted for 68% of
the 78 episodes of neurologic complications. A total of 51 patients and 53
episodes were detailed as follows: 25 episodes of stroke (25 of 78 total
episodes, 32%; 19 ischemic, 6 hemorrhagic); 7 neuropathies; 6 seizures; 4
episodes of transient ischemic attack (TIA); 3 anoxic encephalopathy; 2 each
brachial plexus palsy and metabolic encephalopathy; and 1 each myoclonia, central
nervous system (CNS) lymphoma, subdural hematoma, and Cotard syndrome. Mean time 
to presentation of stroke, TIA, and encephalopathy was 1 day (range, 1-19 d)
posttransplant. Mortality rate among non-infectious complications was 12/53
(22.6%). Infectious complications accounted for 32% of the 78 total episodes. We 
found 25 episodes in 24 patients: 17 herpes zoster (median, 268 d after HT), 3
CNS aspergillosis (median, 90 d after HT), 1 CNS toxoplasmosis and tuberculosis
(51 d after HT), 1 pneumococcal meningitis (402 d after HT), and 2 Listeria
meningitis (median, 108 d after HT). The 3 patients with CNS aspergillosis died. 
The mortality rate among patients with infectious neurologic complications was
12% (42.8% if the CNS was involved). When we compared the OKT3-ATG and daclizumab
groups, we found that the incidence of non-infectious complications was 15.1% vs.
7.3%, respectively, and the incidence of infectious complications was 7.5% vs.
1.4%, respectively. All but 1 opportunistic infection occurred in the OKT3-ATG
time period. In conclusion, a wide variety of neurologic complications affected
19.5% of HT recipients. Non-infectious causes clearly predominated, but
infections still accounted for 32% of the episodes. New monoclonal induction
therapies have contributed to diminished CNS opportunistic infections in our
program.

PMID: 20453603 [PubMed - indexed for MEDLINE]


14. Pain. 2010 May 6. [Epub ahead of print]

Natural history of sensory function after herpes zoster.

Petersen KL, Rowbotham MC.

UCSF Pain Clinical Research Center, Department of Neurology, University of
California, San Francisco, CA, USA.

The natural history of sensory function in the first 6months after herpes zoster 
(HZ) was determined in a cohort of 94 subjects at elevated risk for developing
post-herpetic neuralgia (PHN). All four visits included ratings of pain and
sensory symptoms, mapping areas of altered sensation and allodynia, and
quantitative thermal and mechanical sensory testing. The last three visits
included the capsaicin response test. Sensory thresholds in distant control skin 
were stable. Mirror-image skin was persistently hyperesthetic to warming and
mechanical stimuli and hyperalgesic to heat compared to distant control skin. HZ 
skin showed deficits in all thermal modalities. Sensory recovery was limited and 
selective. Allodynia area and severity, hyperalgesia to von Frey hair, and cold
detection threshold improved, but deficits to warmth and heat pain did not.
Capsaicin on HZ skin significantly aggravated pain and allodynia in the majority 
of subjects at 6-8weeks after HZ onset. At study entry, eventual PHN subjects had
significantly more impairment in detecting warmth and cold, a larger area of
altered sensation, a larger area of allodynia, and more severe allodynia. The
results support the study hypothesis that severity of initial injury predicts
PHN, especially impaired cold sensation in HZ skin. The hypothesis that PHN
develops because of a failure to recover normal neural function was not
supported. Sensory recovery proceeded at the same rate in eventual pain-free and 
eventual PHN subjects and is not a requirement for pain resolution. Early
interventions that reduce neural injury or enhance recovery should be of benefit.
Copyright © 2010 International Association for the Study of Pain. Published by
Elsevier B.V. All rights reserved.

PMID: 20452122 [PubMed - as supplied by publisher]


15. Joint Bone Spine. 2010 May 5. [Epub ahead of print]

Infections induced by low-dose corticosteroids in rheumatoid arthritis: A
systematic literature review.

Ruyssen-Witrand A, Fautrel B, Saraux A, Le-Loët X, Pham T.

Service de rhumatologie B, hôpital Cochin, AP-HP, université Paris V
René-Descartes, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.

OBJECTIVE: To study the association between infection risk and low-dose
corticosteroids (LD-CT, defined as a daily dose <10mg/day of prednisone) in
rheumatoid arthritis (RA). METHODS: Data source: a systematic review of the
literature up to June 2009 was performed. Data extraction :all type of
infections: bacterial, viral and postoperative; infection severity, RA activity, 
RA severity, comorbid conditions. Data analysis: descriptive, comparing infection
risk between LD-CT-treated and LD-CT-not treated RA. RESULTS: Of the 1310
screened reports, the literature analysis identified 15 assessing infection risk 
of LD-CT in RA patients. Of the eight reports that studied all types of
infection, six articles found no association between risk of infection and LD-CT,
one showed an association between severe infections and LD-CT (OR=8 [1-64]) and
another showed a dose-dependent association including doses of less than 5mg/day:
RR=1.32 [1.06-1.63] and doses between 6 to 10mg/day: RR=1.95 [1.53-2.46]. Of the 
three trials that studied infection risk secondary to bacteria, one showed an
increased risk (HR=1.7 [1.5-2.0]) while two did not (respectively, exposure to
<5mg/day: OR=1.34 [0.85-2.13]; 6 to 9mg/day: OR=1.53 [0.95-2.48] and <5mg/day:
OR=1.49 [0.82-2.72]; 5 to 10mg/day: OR=1.46 [0.84-2.54]). None of the three
trials studying postoperative infection risk found any association between
infection risk and LD-CT treatment. Two reports studied herpes zoster risk and
found no association with LD-CT. CONCLUSION: There was a paucity of data about
LD-CT and infection risk in RA and that risk seems poorly increased. These
findings need to be confirmed by further studies. Copyright © 2010 Société
française de rhumatologie. Published by Elsevier SAS. All rights reserved.

PMID: 20451437 [PubMed - as supplied by publisher]


16. Gesundheitswesen. 2010 May 4. [Epub ahead of print]

Determination of Vaccination Coverage and Disease Incidence using Statutory
Health Insurance Data.

Reuss A, Feig M, Kappelmayer L, Eckmanns T, Poggensee G.

Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin.

BACKGROUND: The KV-Sentinel, established in 2004, is a joint project of the
Robert Koch Institute and the 17 associations of statutory health insurance
physicians (ASHIPs) in Germany. The ASHIPs provide anonymous physicians billing
data to the Robert Koch Institute. The aim of this article is to describe
methodological approaches for processing these routine data to determine
vaccination coverage and incidence of vaccine preventable diseases. Furthermore, 
we discuss limitations in interpreting these data. METHODS: The ASHIPs perform a 
data query of all vaccinations and of ICD-10 codes for pertussis, measles, mumps,
varicella and herpes zoster and send anonymous data to the Robert Koch Institute.
We perform routine tests to ensure data quality. Study population is the
statutory health insured population (85.5% of the German population). Vaccination
coverage is determined by the number of vaccinated persons and the number of
statutory health insured persons. Incidence is calculated by the number of
diseased persons per 100 000 statutory health insured persons. RESULTS: All 17
ASHIPs participate in the project. In total, 95 905 605 data records for
vaccinations and 4 570 919 data records for pertussis, measles, mumps, varicella 
and herpes zoster were provided from 2004 to 2007. After performing routine tests
with regard to structure and content of data, more than 99% of the data records
can be analysed. In 2007, the majority of given vaccinations were monovalent
vaccinations against influenza (39%) and tick-borne encephalitis (17%). In 2006
and 2007, 1 893 790 data records for diagnoses were provided. Of these, 75% were 
acute diagnoses and of these 70% were confirmed diagnoses. Most often, ICD-10
codes for herpes zoster (57%) and varicella (35%) were reported. CONCLUSION:
Nationwide vaccination coverage of statutory health insured persons by age group 
can be determined by using billing data. It is possible to validate billing data 
of vaccinations with available data from other studies. Interpretation of billing
data of acute vaccine preventable diseases remains challenging because it is
difficult to assess potential under- or overestimation without the possibility of
external validation. Therefore, further research is needed. © Georg Thieme Verlag
KG Stuttgart · New York.

PMID: 20446216 [PubMed - as supplied by publisher]


17. Immunol Cell Biol. 2010 May;88(4):416-23.

Viruses and Langerhans cells.

Cunningham AL, Abendroth A, Jones C, Nasr N, Turville S.

Centre for Virus Research, Westmead Millennium Institute, New South Wales,
Australia. Tony_Cunningham@wmi.usyd.edu.au

Langerhans cells (LCs) are the resident dendritic cells (DCs) of epidermis in
human mucosal stratified squamous epithelium and the skin. A phenotypically
similar DC has recently been discovered as a minor population in the murine
dermis. In epidermis, LCs function as sentinel antigen-presenting cells that can 
capture invading viruses such as herpes simplex virus (HSV), varicella-zoster
virus (VZV) and human immunodeficiency virus (HIV). This interaction between LCs 
and viruses results in highly variable responses, depending on the virus as
discussed in this review. For example, HSV induces apoptosis in LCs but HIV does 
not. LCs seem to be the first in a complex chain of antigen presentation to T
cells in lymph nodes for HSV and possibly VZV, or they transport virus to T
cells, as described for HIV and maybe VZV. Together with epidermal keratinocytes 
they may also have a role in the initial innate immune response at the site of
infection in the epidermis, although this is not fully known. The full spectrum
of biological responses of LCs even to these viruses has yet to be understood and
will require complementary studies in human LCs in vitro and in murine models in 
vivo.

PMID: 20445632 [PubMed - in process]


18. J Infect Dis. 2010 Jun 15;201(12):1806-10.

Effectiveness of varicella vaccine in children infected with HIV.

Son M, Shapiro ED, LaRussa P, Neu N, Michalik DE, Meglin M, Jurgrau A, Bitar W,
Vasquez M, Flynn P, Gershon AA.

Columbia University College of Physicians and Surgeons, New York, New York 10032,
USA.

Although varicella vaccine is given to clinically stable human immunodeficiency
virus (HIV)-infected children, its effectiveness is unknown. We assessed its
effectiveness by reviewing the medical records of closely monitored HIV-infected 
children, including those receiving highly active antiretroviral therapy (HAART) 
between 1989 and 2007. Varicella immunization and development of varicella or
herpes zoster were noted. Effectiveness was calculated by subtracting from 1 the 
rate ratios for the incidence rates of varicella or herpes zoster in vaccinated
versus unvaccinated children. The effectiveness of the vaccine was 82% (95%
confidence interval [CI], 24%-99%; [Formula: see text]) against varicella and was
100% (95% CI, 67%-100%; [Formula: see text]) against herpes zoster. When the
analysis was controlled for receipt of HAART, vaccination remained highly
protective against herpes zoster.

PMCID: PMC2871955 [Available on 2011/6/15]
PMID: 20441519 [PubMed - in process]


19. Ann Intern Med. 2010 May 4;152(9):609-11.

The looming rash of herpes zoster and the challenge of adult immunization.

Donahue JG, Belongia EA.

Comment on:
    Ann Intern Med. 2010 May 4;152(9):545-54.
    Ann Intern Med. 2010 May 4;152(9):555-60.

PMID: 20439578 [PubMed - in process]


20. Ann Intern Med. 2010 May 4;152(9):555-60.

Barriers to the use of herpes zoster vaccine.

Hurley LP, Lindley MC, Harpaz R, Stokley S, Daley MF, Crane LA, Dong F, Beaty BL,
Tan L, Babbel C, Dickinson LM, Kempe A.

The Children's Hospital of Denver, University of Colorado Denver, USA.

Comment in:
    Ann Intern Med. 2010 May 4;152(9):609-11.

Comment on:
    Ann Intern Med. 2010 May 4;152(9):I36.

BACKGROUND: The herpes zoster vaccine is the most expensive vaccine recommended
for older adults and the first vaccine to be reimbursed through Medicare Part D. 
Early uptake has been 2% to 7% nationally. OBJECTIVE: To assess current
vaccination practices, knowledge and practice regarding reimbursement, and
barriers to vaccination among general internists and family medicine physicians. 
DESIGN: Mail and Internet-based survey, designed through an iterative process and
conceptually based on the Health Belief Model. SETTING: National survey conducted
from July to September 2008. PARTICIPANTS: General internists and family medicine
physicians. MEASUREMENTS: Survey responses on current vaccination practices,
knowledge and practice regarding reimbursement, and barriers to vaccination.
RESULTS: Response rates were 72% in both specialties (301 general internists and 
297 family medicine physicians). Physicians in both specialties reported similar 
methods for delivering vaccine, which included stocking and administering the
vaccine in their offices (49%), referring patients to a pharmacy to purchase the 
vaccine and bring it back to the office for administration (36%), and referring
patients to a pharmacy for vaccine administration (33%). Eighty-eight percent of 
providers recommend herpes zoster vaccine and 41% strongly recommend it, compared
with more than 90% who strongly recommend influenza and pneumococcal vaccines.
For physicians in both specialties, the most frequently reported barriers to
vaccination were financial. Only 45% of respondents knew that herpes zoster
vaccine is reimbursed through Medicare Part D. Of respondents who began
administering herpes zoster vaccine in their office, 12% stopped because of cost 
and reimbursement issues. LIMITATIONS: Survey results represent reported but not 
observed practice. Surveyed providers may not be representative of all providers.
CONCLUSION: Physicians are making efforts to provide herpes zoster vaccine but
are hampered by barriers, particularly financial ones. Efforts to facilitate the 
financing of herpes zoster vaccine could help increase its use. PRIMARY FUNDING
SOURCE: Centers for Disease Control and Prevention.

PMID: 20439573 [PubMed - in process]