Assessing and Improving Zoster Vaccine Uptake in a Homeless Population
Assessing and Improving Zoster Vaccine Uptake in a Homeless Population
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DOI：
10.1007/s10900-018-0517-x
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发表时间：
2018-12-01
影响因子：
5.9
通讯作者：
Crump, Casey
中科院分区：
文献类型：
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作者：
Kaplan-Weisman, Laura;Waltermaurer, Eve;Crump, Casey
带状疱疹(带状疱疹)疫苗推荐给所有60岁且无禁忌症的成年人，以预防带状疱疹和带状疱疹后神经痛。目前还没有关于经历过无家可归的成年人的带状疱疹疫苗接种率、障碍或工作流程的研究发表。由于这种疫苗特有的障碍，包括难以确定保险覆盖范围、高昂的前期成本、需要在冰箱中储存以及医生处方不足，与其他推荐给老年人的疫苗相比，接种率较低。为了解决这些障碍，我们开发了一种新的方法，将我们在过渡性无家可归者收容所的现场初级保健诊所与当地一家药房合作，并在带状疱疹免疫日提供疫苗接种，目标是达到或超过全国带状疱疹免疫接种率30.6%。在3年的时间里，86%的合格患者接种了带状疱疹减毒活疫苗，接种率为38.1%。这高于估计的全国接种率，但明显低于同一人群中的破伤风疫苗接种率(80.6%)、肺炎球菌疫苗接种率(76.3%)和流感疫苗接种率(69.6%)，凸显了带状疱疹免疫接种的独特障碍。患者没有接种疫苗的主要原因包括没有保险覆盖和患者拒绝接种所有疫苗。我们的发现表明，无家可归的成年人对带状疱疹疫苗接种感兴趣，在收容所提供现场初级保健的模式与药房合作可以成功地提高这一人群的疫苗接种率。将新型带状疱疹灭活疫苗纳入医疗保险B部分，可提高全国带状疱疹疫苗接种率。
The herpes zoster (shingles) vaccine is recommended for all adults aged >= 60 years without contraindications to prevent shingles and post-herpetic neuralgia. There are no published studies on zoster vaccination rates, barriers, or workflows in adults who have experienced homelessness. Due to barriers specific to this vaccine, including difficulty determining insurance coverage, high upfront costs, need for storage in a freezer, and under-prescription by physicians, uptake is lower compared to other recommended vaccines for older adults. To address these barriers, we developed a new approach of partnering our on-site primary care clinic in a transitional homeless shelter with a local pharmacy and offering vaccination on Shingles Immunization Days with a goal of matching or exceeding the national zoster immunization rate of 30.6%. Over a 3-year period, the live attenuated zoster vaccine was offered to 86% of eligible patients resulting in an immunization rate of 38.1%. This is higher than the estimated national rate but significantly lower than rates of tetanus (80.6%), pneumococcal (76.3%), and influenza (69.6%) vaccination in the same population, highlighting the unique obstacles to zoster immunization. Major reasons that patients were not immunized included lack of insurance coverage and patient refusal of all vaccines. Our findings demonstrate that homeless adults are interested in zoster vaccination and a model of on-site primary care in a shelter partnering with a pharmacy can successfully improve vaccine uptake in this population. Coverage of the new inactivated zoster vaccine under Medicare Part B could increase the national zoster immunization rate.