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  • Knowledge, Attitudes and Beliefs of Older Canadians and Their Healthcare Providers Regarding Shingles VaccineD Shaw, D Cravit & S McNeilJune 2, 2008

  • BackgroundShingles (herpes zoster) carries a significant burden of disease particularly in those over 60y130,000 cases of shingles360,000 health care visits17,000 cases of post-herpetic neuralgia (PHN)2,000 hospitalizations Contributes to 20 deathsAnnual healthcare cost est $69 million Brisson M. J Infect. 2002

  • Shingles VaccineNew live-attenuated vaccine against shingles (Zostavax, Merck) to be approved in Canada in near future

  • ObjectivesWhat is the perceived burden of illness of shingles among Canadians over 60y?Are older Canadians willing to receive the shingles vaccine?Are healthcare providers for older Canadians (family, internal, geriatrics, infectious diseases, dermatology) willing to recommend the shingles vaccine?Who do these groups think should pay for the shingles vaccine?

  • MethodsSurveys designed, tested for content validity and test-retest reliability and piloted Web-based survey emailed to members of the Canadian Association of Retired Persons aged 60yWeb-based and paper-based survey distributed to NS physicians- Family Medicine, Internal Medicine, Geriatrics, Dermatology, Infectious Diseases

  • Results603 older Canadian responses; all Provinces and Territories represented161 NS physician responses (25% response rate)No differences in main outcomes by age, gender, province/territory of residence (older), education (older), income (older), specialty of medicine (physician), years spent in practice (physician)

  • Results Burden of Shingles48% of older Canadians reported at least one episode of shingles 40% experienced PHN82% older Canadians had friend/family member with shingles

  • Results- Vaccine Acceptability87% of older Canadians willing to receive the vaccine if safe and recommended by physician87% think vaccine should be publicly funded for those over 60y67% willing to pay out-of-pocket93% of NS physicians indicated willing to recommend vaccine if it prevents shingles94% of NS physicians think vaccine should be publicly funded for those over 60y

  • Results- Factors associated with older Canadian willingness to receive shingles vaccine (regression)

  • Results: Variables associated with Physician willingness to recommend shingles vaccine

  • SummaryShingles associated with significant burden of illness Majority of older adults would accept vaccine if recommended by their physician (87%)93% of NS physicians responsible for healthcare of elderly intend to recommend shingles vaccine Majority of older adults (87%) and physicians (94%) believe that shingles vaccine should be publicly funded for older Canadians; smaller majority of older Canadians willing to pay for shingles vaccine out-of-pocket

  • ConclusionDemand for the shingles vaccine is likely to be high among older Canadians and their healthcare providersCareful consideration of program feasibility and cost effectiveness of publicly-funded shingles vaccine is warranted

  • AcknowledgementsDalhousie Music-in-Medicine ProgramCapital Health Research FundBrian Hoyt Petra RykersKimberly Brooks

  • Questions

    Overall Efficacy of the Zoster VaccineIn the Shingles Prevention Study, the zoster vaccine significantly reduced both the incidence of zoster and the incidence of PHN compared with placebo.The zoster vaccine reduced the incidence of zoster by 51.3% (95% CI, 44.2% to 57.6%.1The zoster vaccine reduced the incidence of PHN by 66.5% (95% CI, 47.5% to 79.2%).1 The zoster vaccine also significantly reduced acute and chronic zoster-associated pain as measured by the zoster pain Burden of Illness (BOI) score.The zoster vaccine reduced zoster-associated pain by 61.1% (95% CI, 51.1% to 69.1%).1