Substantial economic and public-health consequences are likely to occur if gaps in herpes zoster (HZ) vaccination status continue for blacks versus whites, especially as the elderly U.S. population increases, according to a new study.
The report in the International Journal of Environmental Research and Public Health points out that despite long-standing disparity between blacks and whites in receiving the live, attenuated version of the vaccine (ZVL), no studies have been conducted to help quantify the public-health and economic consequences associated with the disparity.
Howard University researchers explain that they opted to look at ZVL because not enough data were available on the adjuvanted recombinant subunit zoster vaccine, which was approved last year by the FDA.
Study objectives were to estimate the number of preventable cases HZ occurring in elderly blacks due to failure to achieve health equity in ZVL vaccination status and to quantify the economic burden associated with the disease.
Background information in the article notes that initial uptake of the vaccine was low among all seniors, with 7.5% of whites and 2.5% of blacks receiving the vaccine by 2008. With Healthy People 2020 targets set for 30% of eligible seniors to get the vaccine, recent surveillance data indicate that the proportion of all seniors aged at least 60 years receiving ZVL nearly doubled from 2011 to 2015, increasing from 15.8% to 30.6% during the time period.
At the same time, however, the disparity between blacks and whites has increased: in 2015, 34.6% of whites aged 60 at least years had received ZVL, in contrast to 13.6% of blacks in the same age group.
Costs will be high if that trend continues, according to a simulation designed by the researchers. Results demonstrate that more than 34,500 cases of HZ could be avoided by equalizing ZVL vaccination rates for the cohort of elderly blacks aged 60 to 84 years over a 20-year period. At the same time, the study team calculated, more than $182,000 in costs related to treatment of the disease and lost productivity would be averted.
“Our study demonstrated that the greatest impact of these disparities would be realized among those seniors below the age of 70. This is due in part to the fact that the vaccine is less effective in older populations,” the authors write.
The report suggests, “Pharmacists may be well positioned to assist in the provision of ZVL as they are familiar with Medicare Part D and are able to accommodate the special storage requirements. Multiple studies illustrate the success of promotional campaigns conducted in community pharmacies that have helped to increase uptake of ZVL. Promotional campaigns like these may be one of the contributing factors in the promising increase seen in the uptake of the vaccine among elderly whites in recent years, as they have already exceeded Healthy People 2020 goals. Indeed, one-third of individuals receiving the vaccine cited media or advertisements as one of the venues through which they were made aware of the vaccine.”
The study authors cite research indicating significantly lower awareness of the vaccine among blacks compared with whites, suggesting that promotion of the vaccine might be missing minority patients.
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