Primary care physicians' experience with zoster vaccine live (ZVL) and awareness and attitudes regarding the new recombinant zoster vaccine (RZV)
Primary care physicians' experience with zoster vaccine live (ZVL) and awareness and attitudes regarding the new recombinant zoster vaccine (RZV)
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DOI：
10.1016/j.vaccine.2018.09.018
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发表时间：
2018-11-19
期刊：
影响因子：
5.5
通讯作者：
Kempe, Allison
中科院分区：
文献类型：
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作者：
Hurley, Laura P.;Allison, Mandy A.;Kempe, Allison
背景资料：自2008年以来，免疫实践咨询委员会（ACIP）一直定期建议60岁以上的成年人接种带状疱疹活疫苗（ZVL）;到2016年，只有33%的合格成年人接种了疫苗。重组带状疱疹疫苗（RZV）于2017年获得许可，ACIP于2018年1月推荐。我们的目标是评估初级保健医生（1）对ZVL的实践和态度，（2）对RZV的认识。方法：我们从2016年7月至9月对全国953名初级保健医生进行了互联网和邮件调查。结果：回复率为65%（603/923）。93%的医生推荐ZVL给≥ 60岁的成年人，但较少推荐给≥ 60岁有带状疱疹病史的成年人（88%），> 85岁的成年人（62%）和>= 60岁接受低剂量甲氨蝶呤的成年人（42%）。一些医生推荐ZVL的方式不是ACIP推荐的，包括50-59岁的成年人（50%），≥ 60岁的HIV感染者（33%）和≥ 60岁的高剂量泼尼松（≥ 20 mg/天）的成年人（27%）。19%的医生储存和管理ZVL，没有将患者转诊到其他地方接种疫苗，37%的医生没有储存，只将患者转诊到其他地方接种疫苗，44%的医生储存/管理和转诊到其他地方。23%（n = 115）曾在办公室使用ZVL的医生（n = 490）已经停止，主要原因是财务问题（90%）。只有5%的人“非常了解”RZV。结论：医生报告不向ACIP推荐的某些群体推荐ZVL，但报告向一些应避免接种疫苗的群体推荐ZVL。实施RZV的建议将需要考虑财务障碍以及ZVL遇到的办公室和药房交付的复杂拼凑。(C)2018爱思唯尔有限公司版权所有
Background: The Advisory Committee on Immunization Practices (ACIP) has routinely recommended zoster vaccine live (ZVL) for adults >= 60 since 2008; only 33% of eligible adults received it by 2016. A recombinant zoster vaccine (RZV) was licensed in 2017 and ACIP recommended in January 2018. Our objectives were to assess among primary care physicians (1) practices and attitudes regarding ZVL and (2) awareness of RZV.Methods: We administered an Internet and mail survey from July to September 2016 to national networks of 953 primary care physicians.Results: Response rate was 65% (603/923). Ninety-three % of physicians recommended ZVL to adults >= 60, but fewer recommended it to adults >= 60 with a prior history of zoster (88%), adults > 85 (62%) and adults >= 60 on low-dose methotrexate (42%). Several physicians recommended ZVL in ways that are not recommended by ACIP including to adults 50-59 (50%), adults >= 60 with HIV (33%), and adults >= 60 on high dose prednisone (>= 20 mg/day) (27%). Nineteen percent of physicians stocked and administered ZVL and did not refer patients elsewhere for vaccination, 37% did not stock and only referred patients to receive it, and 44% both stocked/administered and referred elsewhere. Twenty-three % (n = 115) of physicians who had ever administered ZVL in the office (n = 490) had stopped, citing primarily financial issues (90%). Only 5% were 'very aware' of RZV.Conclusions: Physicians report not recommending ZVL to certain ACIP-recommended groups, but report recommending it to some groups for which the vaccine should be avoided. Implementation of recommendations for RZV will need to consider financial barriers and the complex patchwork of office-based and pharmacy delivery ZVL has encountered. (C) 2018 Elsevier Ltd. All rights reserved.