“Adult vaccination is not a fad nor does it have to do only with COVID. It is a scientific conquest”, claims the doctor María José Pereira Rodríguez, head of the Preventive Medicine Service of the health area of A Coruña and Cee, when assessing the recent incorporation of the herpes zoster vaccine to the Galician public health offer for citizens born in 1943 and 1958, that is, those who turn 80 and 65 this 2023. One year ago, the Servizo Galego de Saúde (Sergas) began to offer this vaccination option to people over 18 belonging to high-risk groups, and this spring it has gone a step further, by opening immunization to these two specific age groups. “And surely it will be expanded depending on how the process goes,” he advances.
What is herpes zoster?
It is nothing more than the reactivation of a previous infection. The second face of chickenpox. First, the chickenpox infection occurs, with symptoms or not, and if the virus remains confined to the nerve roots and there is a situation that determines a drop in defenses, herpes zoster appears. What we know, classically, as shingles: lesions in a nervous metamera, with a gallbladder and that hurt. They can get infected, but above all they hurt. In addition, it can bring with it postherpetic neuralgia, a pathology that, from the point of view of quality of life, can be very important.
What does it consist of?
It is a pain of a neuritic nature, located in the area of the herpes zoster lesions despite the fact that they have disappeared and which occurs in approximately one in ten patients with this viral infection. Postherpetic neuralgia produces a clear reduction in the quality of life of those who suffer from it, especially when it affects an older population or those with immunosuppression.
Why has it been decided to vaccinate now against herpes zoster?
Some time ago, the possible immunization against herpes zoster was evaluated, already in the Vaccination Report of the Ministry of Health, and it was suggested that, at the time the vaccine was available —the one we have now, which can be used both in healthy patients as well as in immunosuppressed ones, since before there was another one that could not be used in this second group of patients—, it was necessary to start administering it. When this happened, although the populations at risk were defined and there was already talk of age groups and pathologies, there was a possible difficulty in supplying the entire population that needed it, hence, as on other occasions, prioritizations were made . On this occasion, it was decided to start with immunocompromised patients, with a higher risk than the general population.
For example?
Patients with autologous transplantation of hematopoietic progenitors; with solid organ transplantation; with treatment with anti-JAK drugs; stable people on antiretroviral therapy; with malignant blood diseases; and with solid tumors being treated with chemotherapy. Among all of them, the first ones are the ones with the highest risk.
How much?
If in the general population we say that there may be between 3-5 cases of herpes zoster per thousand inhabitants per year, in patients with hematopoietic stem cell transplants we would be talking about 160-200 cases. In the other groups of patients mentioned, the risk is also increased, although not as much.
And in the elderly?
In the population over 65 years of age, the risk is also higher and is multiplied by two, therefore, we would be talking about 7 cases per thousand inhabitants per year. Given all this situation, it is proposed to start vaccination in immunosuppressed patients, the population that can be clearly addressed and that is more vulnerable. This was what was done a year ago, and now that the system can already guarantee vaccination coverage, it has been decided to address vaccination against herpes zoster in the older population, but in a somewhat orderly manner.
What does it mean?
This spring the vaccine began to be offered to citizens who were born in 1943 and 1958, that is, who are turning 80 and 65 this year, respectively.And surely it will be expanded depending on how the process goes.
How has vaccination of immunocompromised patients gone so far?
To the Preventive Medicine services, the start of vaccination against herpes zoster caught us with all the interference that COVID caused in our activity, and the will we have is to gradually recapture citizens who are in this situation, and vaccinate risk patients who already come to our consultation. Although the activities are not yet closed, it is likely that in our center we will have to carry out some type of active recruitment campaign, to remind patients that we perhaps saw years ago for these risk pathologies, who need this vaccination. Since we were authorized to administer the herpes zoster vaccine to immunosuppressed patients, we have been giving it to the patients who come to our office, and now we have to make an effort to attract those who did so previously and have not received it. . Because we do believe that adult vaccination is not a fad.
What is it referring to?
We have an increasing number of vaccine arsenals that tell us that adult vaccination is clearly indicated because it offers more benefits than risks. And, in the case of this vaccine against herpes zoster, like many others that are to come, it must be clear that they do not only seek to prevent mortality —although there are deaths from this viral infection, but in a very limited number—, but to prevent the decrease in the quality of life that it can produce, for this reason it is advisable to put it on. It is an absolutely safe vaccine, and its proven effectiveness is close to 98% to prevent herpes zoster, while in the case of postherpetic neuralgia, it is close to one hundred percent. Adults must understand that, just as we incorporate habits such as a healthy diet or regular physical activity, we have certain vaccines that also contribute to this strategy of giving quality to our lives. And that of herpes zoster is a good example.
What do you think of the adult vaccination schedule in Galicia?
Although I was once a bit critical of the rate of incorporation of adult vaccination, now it can be said, with full conviction, that the Galician vaccination calendar, both for children and adults, is the most complete at the national level. There is no vaccine available, whose usefulness has been recommended at the population or individual level, that is not included at this time. But having the most complete calendar is not enough. Vaccines have to be administered, and this is something that patients have to understand, and health professionals too. It is useless to have a document that includes the possibility of vaccinating, if it is not done. For example, in the case of pneumococcus, we have seen how children are being vaccinated and the disease has decreased a lot, however, in adults much remains to be done.
Do you think that the successive campaigns against COVID have been able to generate some fatigue in the adult population when it comes to getting vaccinated?
Even having achieved vaccination coverage against COVID in Galicia that is a national reference, we cannot look the other way or fail to recognize that this is the case. We have gone from adults only getting vaccinated against tetanus, and in some cases against the flu, to administering a series of injections, which have also been modified over time. That is why it is so important to convey the reason for these recommendations, and to make the population understand that vaccines are not a fad: they have always been there and have been the only health strategy capable of eliminating diseases such as smallpox, for example. But they are not products that are easily built or made. They need a series of conditions, both from the disease, from the microorganism, from safety, from the time of immunity… which means that they are gradually incorporated. It is true that now there is a level of research and commitment to vaccinology that there was not twenty years ago, and we are going to have more and more news of this type.
The most imminent?
I am convinced that, within a year, we will be talking about respiratory syncytial virus (RSV) vaccination also for adults, for pregnant women. This is not a fad nor does it have to do only with COVID. It is a scientific conquest: the achievement of many researchers; of many professionals dedicated to epidemiological surveillance; of a lot of staff, both doctors and nurses, who work to administer the vaccines… and in all this we have to continue making an effort, because prevention is the best health tool. And vaccines are pure and hard prevention.
2023-05-27 02:00:11
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