Sir, – I am deeply disappointed at the Health Information and Quality Authority’s publication of its draft health technology assessment on the addition of herpes zoster (shingles) vaccination to the adult vaccination programme (“Shingles vaccine too expensive for routine immunisation, Hiqa finds”, News, March 19th). It fails to recommend shingles vaccination as part of our adult vaccination programme for vulnerable people because of cost (HIQA quotes ¤151 per dose; two doses are required in a course).
This contrasts with the US, Canada, Australia, the UK and other European countries.
Shingles can affect people of any age but older people and younger people with reduced immunity are particularly affected: 60 per cent of shingles occurs in those aged over 60, and 30 per cent of all people will experience at least one episode of shingles in their lifetime.
Severe post-herpetic neuralgia (persistent nerve pain) is common in 20 per cent of cases.
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‘I could have gone to California. At this rate, I probably would have raised about half a billion dollars’
Another 20 per cent can have nerves of their face and head involved which, if it affects the nerves supplying the eyes, can cause serious eye damage, including loss of or impaired vision of the eye involved.
As a geriatrician, I have dealt with large numbers of cases over my professional career, and I was looking forward to the advent of a safe, effective vaccine against shingles which we now have in the form of a recombinant shingles (zoster) vaccine.
When talking about shingles vaccine, it is very important to focus on the better tolerated more recently introduced recombinant zoster (shingles) vaccine which is administered in a course of two doses.
The US Centres for Disease Control and Prevention (CDC) recommends that adults 50 years and older get two doses of this recombinant shingles (zoster) vaccine.
The CDC quotes research that showed that two doses of recombinant shingles (zoster) vaccine provide strong protection against shingles and post-herpetic neuralgia), the most common complication of shingles.
In adults 50 to 69 years old with healthy immune systems, recombinant zoster (shingles) vaccine was 97 per cent effective in preventing shingles; in adults 70 years and older, it was 91 per cent effective.
In adults 50 years and older, recombinant zoster (shingles) vaccine was 91 per cent effective in preventing post-herpetic neuralgia (PHN).
In adults with weakened immune systems, recombinant zoster (shingles) vaccine was between 68 per cent and 91 per cent effective in preventing shingles, depending on their underlying immunocompromising condition.
In people over 70 years, immunity post-recombinant zoster (shingles) vaccination remained high throughout seven years following vaccination.
HIQA says that their technology assessment is a draft document for public consultation.
Hopefully, the Minister for Health, Department of Health and the HSE will follow the lead of the US and other countries in Europe and abroad who have recently placed recombinant shingles (zoster) vaccine on their recommended adult vaccination programmes.
I earnestly request them to follow the advice of the US and other countries in recommending recombinant shingles (zoster) vaccine for all over-fifties and for all over 18 who have an impaired immune system.
It is crucial that recombinant zoster (shingles) vaccination becomes part of our adult vaccination programme. – Yours, etc,
Prof J BERNARD WALSH,
(Clinical Professor,
St James’s Hospital and Trinity College Dublin),
Blackrock,
Co Dublin.