A focus on vaccination against Herpes zoster and on the opportunities offered by the new prevention tool in the Tuscany region. It happened during the webinar “Update: the new adult vaccines, focus Herpes Zoster”, organized by Farecomunicazione, which compared experts and clinicians.
To date, there are about 150 thousand Italians affected by the so-called “St. Anthony’s fire”, a figure that affects the population more than 50 years old (even one in two people over 85). The 2017-2019 National Prevention Plan introduced vaccination from the age of 65 and for 50-year-olds suffering from specific pathologies.
The presence of a new vaccine therefore requires an assessment that takes into account its potential as a prevention tool and that integrates with an organizational model conditioned by the anti Covid vaccination plans19.
“The Tuscany region was affected by the emergency caused by SarsCov2 – says Emanuela Balocchini, head of the collective prevention sector of the Tuscany Region -. For twenty-five years we have equipped ourselves with a regional vaccines commission, which is taking over planning again. At the moment the attention is still catalyzed by the anti Covid vaccination, however we enjoy a regional organizational model that focuses on territorial medicine for vaccination, general practitioners and pediatricians of free choice. Among other things, we are one of the few regions that has entrusted anti-Covid prophylaxis to family doctors and, despite the difficulties, thanks to this system we have maintained vaccination coverage above 95% for children at 24 months. ”
For adults and herpes zoster, on the other hand, it is necessary to implement the method with territorial medicine, which is able to offer continuous consultation with patients. “Tuscany has a great tradition on vaccinations – concludes Balocchini -, although it is a practice that is a victim of its own success. As soon as a disease regresses, it is thought that it is no longer there and the need to resort to the vaccine is less felt. For this reason the dialogue with the family doctor is fundamental; on the other hand, anyone who knows what post-herpetic neuralgia is gets vaccinated in a hurry. ”
Raising awareness of the population is an aspect on which even Paolo Bonanni, full professor of Hygiene at the University of Florence, focuses a lot. “The problem concerns not only frail patients, but a significant portion of the population and the new vaccine allows us to give excellent answers in terms of efficacy and duration over time even in those who are immunocompromised. Age is a predisposing factor, but some chronic diseases are also conditions of high risk ”.
The prospect offered by the new vaccine would greatly improve prevention, given that shingles is more recurrent in frail patients than in healthy peers. Another aspect to reflect on is the duration, given that “according to various studies, an important decrease in the efficacy of the previous live attenuated vaccine emerges in the following 7-10 years from administration – explains Bonanni -. It follows that only 21% of the vaccinated population is still protected ”. “Recently the Calendar for Life recommended the use of this new vaccine for efficacy and duration – continues Bonanni -. The results of the Health Technology Assessment reports are awaited, to evaluate the definitive preferability of the adjuvanted recombinant vaccine, also in pharmaco-economic and organizational terms. However, the board asks for immediate use considering the growing incidence of herpes zoster, which has major complications in immunocompromised individuals. And then we will have to extend its progressive use to the rest of the population, and consider it an investment as a therapeutic measure “.
In immunosuppressed patients, herpes zoster can lead to greater complications, up to involving organs with focuses in the lungs or brain, so “the vaccine is not just a preventive but a therapeutic action for these patients”, underlines Letizia Attala, SOC infectious specialist Infectious diseases 1 of the Santa Maria Annunziata Hospital in Florence. “The recombinant vaccine is recommended in the guides for rheumatological diseases, while phase two and three studies are underway for patients with haematological diseases. Also in patients with solid tumors we are studying at which therapeutic phase it is appropriate to vaccinate “. Encouraging results also come from the phase one and two study of different cohorts of HIV patients and from a study on kidney transplants.
Therefore, the role not only of the specialist is central: general medicine is also fundamental in the vaccination of adults and Tuscany was the first region in Italy to entrust the practice to the clinics of family doctors. An agreement two years ago that suffered the impact of the pandemic, but which provides that “the doctor can do all the vaccinations provided for in the Lea and in line with the National Vaccine Prevention Plan – underlines Elisabetta Alti, director of the Department of Medicine general of the ASL Tuscany center -. The organizational model must be implemented, but we take into account that last autumn we general practitioners vaccinated 13 million people, so we can say that we are well on the way. We are a point of reference, widespread throughout the territory and more accessible than a vaccination center. Of course, the distribution of the vaccine must be appropriate to the user and equally capillary. The new vaccine is better transportable and can be co-administered, a very important aspect to consider. And having to do two doses is not a problem: we have seen that for the Covid vaccine the adhesion was still high. “