Advertisement

National and State-Specific Shingles Vaccination Among Adults Aged ≥60 Years

Published:October 05, 2016DOI:https://doi.org/10.1016/j.amepre.2016.08.031

      Introduction

      Shingles (herpes zoster) causes substantial morbidity, especially among older adults. The shingles vaccine has been recommended for people aged ≥60 years since 2006. This study assessed recent shingles vaccination at national and state levels among adults aged ≥60 years.

      Methods

      The 2014 Behavioral Risk Factor Surveillance System data were analyzed in 2015 to assess shingles vaccination coverage among adults aged ≥60 years at national and state levels. Multivariable logistic regression and predictive marginal models identified factors independently associated with vaccination.

      Results

      Shingles vaccination coverage among adults aged ≥60 years was 31.8% (95% CI=31.4%, 32.2%). Among states, shingles vaccination coverage ranged from 17.8% (95% CI=15.8%, 20.0%) in Mississippi to 46.6% (95% CI=44.3%, 48.8%) in Vermont, with a median of 33.3%. Coverage was <25% in four states and >40% in nine states. For all states, coverage was significantly higher among non-Hispanic whites compared with non-white races except for Oregon, with coverage differences ranging from –33.2% in the District of Columbia to 0.9% in Oregon and a median of –16.0%. Characteristics independently associated with vaccination were age, race/ethnicity, sex, education, employment status, household income, region, perceived health status, health insurance status, personal healthcare provider, routine checkup status, and whether reporting that cost was a barrier to seeing a doctor.

      Conclusions

      Coverage varied dramatically by state. State-level comparisons may aid in designing tailored intervention programs through sharing of best practices. Strategies are needed to mitigate financial barriers for both provider and patients, improve awareness, and increase provider recommendation of the vaccine.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Thomas S.L.
        • Hall A.J.
        What does epidemiology tell us about risk factors for herpes zoster?.
        Lancet Infect Dis. 2004; 4: 26-33https://doi.org/10.1016/S1473-3099(03)00857-0
        • Katz J.
        • Copper E.M.
        • Walther R.R.
        • Sweeney E.W.
        • Dworkin R.H.
        Acute pain in herpes zoster and its impact on health related quality of life.
        Clin Infect Dis. 2004; 39: 342-348https://doi.org/10.1086/421942
        • Oxman M.N.
        • Levin M.J.
        • Johnson G.R.
        • et al.
        A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.
        N Engl J Med. 2005; 352: 2271-2284https://doi.org/10.1056/NEJMoa051016
        • Yawn B.P.
        • Saddier P.
        • Wollan St, P.C.
        • Sauver J.L.
        • Kurland M.J.
        • Sy L.S.
        A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction.
        Mayo Clin Proc. 2007; 82: 1341-1349https://doi.org/10.4065/82.11.1341
        • Kilgore P.E.
        • Kruszon-Moran D.
        • Seward J.F.
        • et al.
        Varicella in Americans from NHANES III: implications for control through routine immunization.
        J Med Virol. 2003; 70: S111-S118https://doi.org/10.1002/jmv.10364
        • CDC.
        Prevention of herpes zoster recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR Morb Mortal Wkly Rep. 2008; 57: 1-30
        • Insinga R.P.
        • Itzler R.F.
        • Pellissier J.M.
        Acute/subacute herpes zoster: healthcare resource utilization and costs in a group of U.S. health plans.
        Pharmacoeconomics. 2007; 25: 155-169https://doi.org/10.2165/00019053-200725020-00007
        • Mullooly J.P.
        • Riedlinger K.
        • Chun C.
        • Weinmann S.
        • Houston H.
        Incidence of herpes zoster, 1997—2002.
        Epidemiol Infect. 2005; 133: 245-253https://doi.org/10.1017/S095026880400281X
        • Chen S.Y.
        • Suaya J.A.
        • Li Q.
        • et al.
        Incidence of herpes zoster in patients with altered immune function.
        Infection. 2014; 42: 325-334https://doi.org/10.1007/s15010-013-0550-8
        • Leung J.
        • Harpaz R.
        • Molinari N.A.
        • Jumaan A.
        • Zhou F.
        Herpes zoster incidence among insured persons in the United States, 1993–2006: evaluation of impact of varicella vaccination.
        Clin Infect Dis. 2011; 52: 332-340https://doi.org/10.1093/cid/ciq077
        • Kawai K.
        • Gebremeskel B.
        • Acosta C.J.
        Incidence and complications of herpes zoster: towards a global perspective.
        BMJ Open. 2014; 4: e004833https://doi.org/10.1136/bmjopen-2014-004833
      1. Soni A, Hill SC. Average annual health care use and expenses for HZ among the U.S. civilian noninstitutionalized population, 2003–2005. Statistical brief #194. Rockville, MD: Agency for Healthcare Research and Quality. www.meps.ahrq.gov/mepsweb/data_stats/Pub_ProdResults_Details.jsp?pt=Statistical%20Brief&opt=2&id=842. Published December 2007. Accessed February 8, 2016.

        • Pellissier J.M.
        • Brisson M.
        • Levin M.J.
        Evaluation of the cost-effectiveness in the U.S. of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.
        Vaccine. 2007; 25: 8326-8337https://doi.org/10.1016/j.vaccine.2007.09.066
      2. WebMD. Shingles vaccine to be routine at 60. www.webmd.com/skin-problems-and-treatments/shingles/news/20061025/shingles-vaccine-to-be-routine-at-60. Accessed August 11, 2016.

        • Rothberg M.B.
        • Virapongse A.
        • Smith K.J.
        Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.
        Clin Infect Dis. 2007; 44: 1280-1288https://doi.org/10.1086/514342
        • Kawai K.
        • Preaud E.
        • Baron-Papillon F.
        • Largeron N.
        • Acosta C.J.
        Cost-effectiveness of vaccination against herpes zoster and postherpetic neuralgia: a critical review.
        Vaccine. 2014; 32: 1645-1653https://doi.org/10.1016/j.vaccine.2014.01.058
      3. CDC. BRFSS: overview–BRFSS 2014. www.cdc.gov/brfss/annual_data/2014/pdf/Overview_2014.pdf. Accessed February 8, 2016.

        • CDC
        Methodological changes in the Behavioral Risk Factor Surveillance System in 2011 and potential effects on prevalence estimates.
        MMWR Morb Mortal Wkly Rep. 2012; 61: 410-413
      4. CDC. BRFSS—2014 summary data quality report. www.cdc.gov/brfss/annual_data/2014/pdf/2014_dqr.pdf. Accessed February 8, 2016.

        • Shah B.
        • Barnwell B.
        • Bieier G.
        SUDAAN user’s manual, release 11.01.
        Research Triangle Institute, Research Triangle Park, NC2016
      5. U.S. DHHS. Immunization and infectious diseases. www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases/objectives. Accessed February 10, 2016.

        • Williams W.W.
        • Lu P.J.
        • O’Halloran A.
        • et al.
        Surveillance of vaccination coverage among adult populations—United States, 2014.
        MMWR Surveill Summ. 2016; 65: 1-36https://doi.org/10.15585/mmwr.ss6501a1
        • CDC
        Surveillance of influenza vaccination coverage—United States, 2007-08 through 2011-12 influenza seasons.
        MMWR Morb Mortal Wkly Rep. 2013; 62: 1-29
        • Lu P.J.
        • Euler G.L.
        • Jumaan A.O.
        • Harpaz R.
        Herpes zoster vaccination among adults aged 60 years or older in the United States, 2007: uptake of the first new vaccine to target seniors.
        Vaccine. 2009; 27: 882-887https://doi.org/10.1016/j.vaccine.2008.11.077
      6. CDC. NCHS Health E-Stat. Vaccination coverage estimates from the National Health Interview. www.cdc.gov/nchs/data/hestat/vaccine_coverage/vaccine_coverage.htm. Accessed August 11, 2016.

        • Lu P.J.
        • Nuorti J.P.
        Pneumococcal polysaccharide vaccination among adults aged 65 years and older, U.S., 1989-2008.
        Am J Prev Med. 2010; 39: 287-295https://doi.org/10.1016/j.amepre.2010.06.004
      7. CDC. AdultVaxView. www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/index.html. Accessed March 9, 2016.

        • National Vaccine Advisory Committee
        Recommendations from the National Vaccine Advisory Committee: standards for adult immunization practice.
        Public Health Rep. 2014; 129: 115-123
        • Hurley L.P.
        • Lindley M.C.
        • Harpaz R.
        • et al.
        Barriers to the use of herpes zoster vaccine.
        Ann Intern Med. 2010; 152: 555-560https://doi.org/10.7326/0003-4819-152-9-201005040-00005
        • Klaiman T.
        • Ibrahim J.K.
        State health department structure and pandemic planning.
        J Public Health Manag Pract. 2010; 16: E1-E7https://doi.org/10.1097/PHH.0b013e3181b83475
        • Nelson D.E.
        • Bland S.
        • Powell-Griner E.
        • et al.
        State trends in health risk factors and receipt of clinical preventive services among U.S. adults during the 1990s.
        JAMA. 2002; 287: 2659-2667https://doi.org/10.1001/jama.287.20.2659
        • CDC
        State and sex specific prevalence of selected characteristics—Behavioral Risk Factor Surveillance System, 1996 and 1997.
        MMWR Morb Mortal Wkly Rep. 2000; 49: 1-39
        • CDC
        Surveillance for certain health behaviors among selected local areas—United States, Behavioral Risk Factor Surveillance System, 2011.
        MMWR Morb Mortal Wkly Rep. 2014; 63: 1-149
      8. CDC. FluVaxView. www.cdc.gov/flu/fluvaxview/. Accessed March 9, 2016.

      9. Guide to Community Preventive Services. www.thecommunityguide.org/index.html. Accessed February 11, 2016.

        • CDC
        Update on recommendations for use of herpes zoster vaccine.
        MMWR Morb Mortal Wkly Rep. 2014; 63: 729-731
        • Lu P.J.
        • Singleton J.A.
        • Rangel M.C.
        • Wortley P.M.
        • Bridges C.B.
        Influenza vaccination trends among adults 65 years or older in the United States, 1989-2002.
        Arch Intern Med. 2005; 165: 1849-1856https://doi.org/10.1001/archinte.165.16.1849
        • Singleton J.A.
        • Santibanez T.A.
        • Wortley P.M.
        Influenza and pneumococcal vaccination of adults aged ≥65: racial/ethnic differences.
        Am J Prev Med. 2005; 29: 412-420https://doi.org/10.1016/j.amepre.2005.08.012
        • CDC
        Hepatitis B vaccination coverage among adults—United States, 2004.
        MMWR Morb Mortal Wkly Rep. 2006; 55: 509-511
        • Lu P.J.
        • O’Halloran A.
        • Williams W.W.
        • Lindley M.C.
        • Farrall S.
        • Bridges C.B.
        Racial and ethnic disparities in vaccination coverage among adult populations—United States, 2012.
        Am J Prev Med. 2015; 49(6): S412-S425
      10. Public Health England. Herpes zoster (shingles) immunization program 2013/2014: report from England. www.gov.uk/government/uploads/system/uploads/attachment_data/file/383018/ShinglesReport2014.pdf. Accessed March 9, 2016.

        • Egede L.E.
        • Zheng D.
        Racial/ethnic differences in adult vaccination among individuals with diabetes.
        Am J Public Health. 2003; 93: 324-329https://doi.org/10.2105/AJPH.93.2.324
        • Lu P.J.
        • O’Halloran A.
        • Williams W.W.
        Impact of health insurance status on vaccination coverage among adult populations—United States, 2012.
        Am J Prev Med. 2015; 48: 647-661https://doi.org/10.1016/j.amepre.2014.12.008
        • Vaidya V.
        • Partha G.
        • Karmakar M.
        Gender differences in utilization of preventive care services in the United States.
        J Womens Health (Larchmt). 2012; 21: 140-145https://doi.org/10.1089/jwh.2011.2876
        • Peterson R.L.
        • Saag K.
        • Wallace R.B.
        • Doebbling B.N.
        Influenza and pneumococcal vaccine receipt in older persons with chronic disease: a population-based study.
        Med Care. 1999; 37: 502-509https://doi.org/10.1097/00005650-199905000-00009
        • Lave D.G.
        • Traven N.D.
        • Kuller L.H.
        Participation in health promotion programs by the rural elderly.
        Am J Prev Med. 1995; 11: 46-53
        • Lu P.J.
        • Byrd K.K.
        • Murphy T.V.
        • Weinbaum C.
        Hepatitis B vaccination coverage among high-risk adults 18-49 years, U.S., 2009.
        Vaccine. 2011; 29: 7049-7057https://doi.org/10.1016/j.vaccine.2011.07.030
        • Lu P.J.
        • Nuorti J.P.
        Uptake of pneumococcal polysaccharide vaccination among working-age adults with underlying medical conditions, United States, 2009.
        Am J Epidemiol. 2012; 175: 827-837https://doi.org/10.1093/aje/kwr376
        • Sudano J.J.
        • Baker D.W.
        Intermittent lack of health insurance coverage and use of preventive services.
        Am J Public Health. 2003; 93: 130-137https://doi.org/10.2105/AJPH.93.1.130
      11. Beal AC, Doty MM, Hernandez SE, Shea KK, Davis K. Closing the divide: how medical homes promote equity in health care—results from the Commonwealth Fund 2006 Health Care Quality Survey. The commonwealth Fund, New York, NY. www.commonwealthfund.org/publications/fund-reports/2007/jun/closing-the-divide--how-medical-homes-promote-equity-in-health-care--results-from-the-commonwealth-f. Accessed February 11, 2016.

        • Rolnick S.J.
        • Parker E.D.
        • Nordin J.D.
        • et al.
        Self-report compared to electronic medical record across eight adult vaccines: do results vary by demographic factors?.
        Vaccine. 2013; 31: 3928-3935https://doi.org/10.1016/j.vaccine.2013.06.041
        • Gelb L.D.
        Preventing herpes zoster through vaccination.
        Ophthalmology. 2008; 115(2): S35-S38https://doi.org/10.1016/j.ophtha.2007.10.015
        • Betts R.F.
        Vaccination strategies for the prevention of herpes zoster and postherpetic neuralgia..
        J Am Acad Dermatol. 2007; 57(6): S143-S147https://doi.org/10.1016/j.jaad.2007.09.017
        • Campos-Outcalt D.
        • Jeffcott-Pera M.
        • Carter-Smith P.
        • Schoof B.K.
        Young vaccines provided by family physicians.
        Ann Fam Med. 2010; 8: 507-510https://doi.org/10.1370/afm.1185
        • Wood H.M.
        • McDonough R.P.
        • Doucette W.R.
        Retrospective financial analysis of a herpes zoster vaccination program from an independent community pharmacy perspective.
        J Am Pharm Assoc. 2009; 49: 12-17https://doi.org/10.1331/JAPhA.2009.08030
        • Wang J.
        • Ford L.J.
        • Wingate L.
        • et al.
        Effect of pharmacist intervention on herpes zoster vaccination in community pharmacies.
        J Am Pharm Assoc. 2013; 53: 46-53https://doi.org/10.1331/JAPhA.2013.12019
        • Bryan A.R.
        • Liu Y.
        • Kuehl P.G.
        Advocating zoster vaccination in a community pharmacy through use of personal selling.
        J Am Pharm Assoc. 2013; 53: 70-77https://doi.org/10.1331/JAPhA.2013.11097
        • Otsuka S.H.
        • Tayal N.H.
        • Porter K.
        • Embi P.J.
        • Beatty S.J.
        Improving herpes zoster vaccination rates through use of a clinical pharmacist and a personal health record.
        Am J Med. 2013; 126: e1-e6https://doi.org/10.1016/j.amjmed.2013.02.018
        • Ndiaye S.M.
        • Hopkins D.P.
        • Shefer A.M.
        • et al.
        Task Force on Community Preventive Services: interventions to improve influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among high-risk adults: a systematic review.
        Am J Prev Med. 2005; 28(5): 248-279https://doi.org/10.1016/j.amepre.2005.02.016
        • Ndiaye S.M.
        • Hopkins D.P.
        • Smith S.J.
        • Hinman A.R.
        • Briss P.A.
        Task Force on Community Preventive Services: methods for conducting systematic reviews of targeted vaccination strategies for the guide to community preventive services.
        Am J Prev Med. 2005; 28(5): 238-247https://doi.org/10.1016/j.amepre.2005.02.012
        • Poland G.A.
        • Shefer A.M.
        • McCauley M.
        • et al.
        Standards for adult immunization practice.
        Am J Prev Med. 2003; 25: 144-150https://doi.org/10.1016/S0749-3797(03)00120-X