Dear Sir,
I write to express my severe dissatisfaction with the draft health technology evaluation by the Health Information and Quality Authority, pertaining to the proposal of including herpes zoster (commonly known as ‘shingles’) vaccination into the adult immunisation programme. Their report, issued on March 19, unfortunately does not advise the implementation of shingles vaccination for susceptible adults, primarily due to the alleged price of £151 per dosage, with two required for the full course.
Such an attitude starkly contrasts with health authorities in the United States, Canada, Australia, the UK, and a number of European countries.
Shingles is an affliction that can strike anyone regardless of age, but it disproportionately impacts the older demographic and younger individuals with compromised immune systems. 60% of all shingle cases are in those over the age of 60, and a significant 30% of the population will suffer at least one episode of shingles during their lifetime.
Additionally, serious post-herpetic neuralgia (continual nerve pain) is prevalent in 20% of shingles cases. A further one-fifth may experience nerve involvement in their face and head, potentially affecting their eyes and causing considerable damage, including loss or impairment of vision.
In my professional capacity as a geriatrician, I have managed a high volume of cases throughout my career. I eagerly anticipated the development of a safe and effective shingles vaccination – a hope that has now been fulfilled with the creation of a recombinant zoster vaccine.
When the topic of shingles vaccine arises, our emphasis should be on the newer and more readily accepted recombinant zoster vaccine, which requires a two-dose course. The United States’ Centers for Disease Control and Prevention (CDC) endorses this vaccine for all adults aged 50 and above, citing research that demonstrates its efficacy in significantly protecting against shingles and its most common complication, post-herpetic neuralgia.
According to a report, for individuals between 50 and 69 with intact immunity, the recombinant zoster or shingles vaccine has been found to be 97% effective in warding off shingles, while in those above 70 the efficacy was recorded at 91%. The same vaccine has been noted to be just as effective in preventing post-herpetic neuralgia (PHN) in people over the age of 50. In those with compromised immune systems, the vaccine was recorded as being between 68% and 91% effective in battling shingles based on the type of condition weakening their immune system. Despite age, there has been a lasting high level of immunity sustained for seven years after vaccination in anyone over 70 years of age. As this report by HIQA is open for public consultation, it remains hopeful that figures in Health Department like the Minister for Health and the HSE would push for the inclusion of the recombinant shingles or zoster vaccine in the suggested adult vaccination programme, following the path taken by the US and other nations in Europe and overseas. A strong plea for this inclusion comes from Prof J Bernard Walsh, a clinical professor from St James’s Hospital and Trinity College Dublin, who significantly stresses on the importance of this vaccine’s inclusion into adult vaccination protocols.