The shingles vaccine (Zostavax®)
is produced in the same way as
chickenpox (varicella) vaccine
but contains significantly more
antigen. It appears to be more
effective in preventing shingles
when given to younger adults
aged 50 -60 years but the risk
of severe disease and sequelae
(particularly
neuralgia)
is
greatest in the elderly aged
over 70 years of age. In these
older age groups, the role of
the vaccine is particularly for
reducing the incidence of
debilitating pain and long term
complications. Duration of
immunity has yet to be
ascertained so the optimum
age at which to give shingles
vaccine is unknown. The US
Advisory
Committee
on
Immunization Practices (ACIP)
current recommendation is
that one dose of shingles
vaccine is administered to
immune-competent
adults
aged from 60 years (Hales et al
2014) In the UK and Australia
(from November 2016) it is
offered on the national
schedule to all at 70 years of
age.
Knowledge
about
which
vaccines
to
offer
and
recommend older patients is
important but is unlikely to do
much to improve protection
unless vaccinators discuss
within their practice strategies
to deliver these vaccines. As
mentioned at the start, we can
December 2016 L.O.G.I.C
build on the skills developed
through
vaccinating
our
youngest
patients.
Some
actions we can consider
include:
1. Raising awareness with ALL
provider staff so that they can
play their part. Discuss
incorporating
adult
immunisation into your services
provision and how staff and
time can be dedicated to this,
with practice managers
2.
Utilise
your
patient
management system’s audit
and status query tools to
identify
un(der)-immunised
older adults and put pre-call
and recall systems in place
3. Adopt an opportunistic
immunisation approach at all
consultations with older adults
4. Be aware of which adult
vaccines are added to the
National Immunisation Register
(NIR) and include discussion of
NIR in your consent process
with older patients
5. Have up-to-date, ageappropriate
vaccine
information available in your
waiting areas and consultation
rooms, and use these in vaccine
conversations
with
your
patients. Examples include
Ministry of Health resources;
Adult tetanus and diphtheria
immunisation (HE1514), After
your immunisation (HE2505)
and annual influenza resources
from the National Influenza
Specialist Group resources (see
your 2016 Influenza kit)
As primary health care nurses
we can do more to protect our
patients through immunisation.
You have taken the first step by
reading this article. Now have
discussions with your team to
see what you can do in your
practice to protect your
vulnerable
older
adult
population.
References
CDC
(2011)
Updated
Recommendations for the use of
tetanus toxoid, reduced diphtheria
toxoid and acellular pertussis
(Tdap) vaccine from the Advisory
Committee
on
Immunization
Practices, 2010 Morbidity and
Mortality Weekly Report 14/1/11
60 (1)
ESR (2016) Surveillance Report:
Invasive pneumococcal disease in
New Zealand 2014. Available at
https://surv.esr.cri.nz/PDF_surveill
ance/IPD/2014/2014IPDAnnualRe
port.pdf
Hales CM, Harpaz R, OrtegaSanchez I, Bialek SR (2014) Update
on Recommendations for Use of
Herpes Zoster Vaccine. Morbidity
and Mortality Weekly Report
August 22, 2014 63 (33)
Immunisation Advisory Centre
(2016) IMAC Factsheet: Guide to
additional vaccines for special
groups from 1st March 2016.
Available
at
http://www.immune.org.nz/sites/
default/files/resources/Programm
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