Herpes zoster (HZ) affects 1 in 3 Americans by age 80 and is associated with longer-term complications, such as post-herpetic neuralgia (PHN), with pain extending from 3 months to more than 1 year, explains Barbara P. Yawn, MD, MSc, MSPH.

Research shows that having COPD increases the age adjusted risk for HZ by 31% to 416%. The burden of HZ in individuals with COPD could be reduced by vaccination, which is recommended by the Advisory Committee on Immunization Practices (ACIP) for those aged 19 and older with chronic conditions. However, uptake of HZ vaccination lags behind that of other vaccinations among people with COPD.

For a study published in The Clinical Research Journal, Dr. Yawn and colleagues analyzed data from a large US claims database that underscores a significant increased risk for developing acute HZ in patients with COPD. A second recent report, published in Chronic Obstructive Pulmonary Disease, is an objective, survey-based study that shows that a major need exists for education of health care professionals (HCPs) about HZ and vaccine prevention among patients with COPD.

“Much of the data on the impact of having COPD on the risk [for] HZ are not recent and from studies outside the United States,” Dr. Yawn says. “Our aim with the first study was to fill that gap. While those results are an important guide to clinical therapy,
we also wanted to know whether HCPs were aware of the association with HZ and were encouraging their patients with COPD to be vaccinated for it.”

Claims Analysis Stresses Increased Risk for HZ in COPD

The researchers used de-identified clinical data from a US health insurance claims administrative database plus linked medical services and prescription fill information. “Clinical diagnoses of HZ and its complications in individuals diagnosed with COPD were compared with those in individuals without a COPD diagnosis to obtain age-adjusted rates of HZ occurrence in both groups,” Dr. Yawn notes.

Overall, data from 161,970 adults aged 40 and older with COPD were compared with outcomes from 9.6 million adults of similar age without COPD. The incidence of shingles was 5.7-fold higher in the COPD-positive versus COPD-negative cohorts (13.0 vs 2.3 per 1,000 person-years; adjusted incidence rate ratio [aIRR], 2.77; 95% CI, 2.69-2.85; P<0.001). “The aIRR ratio of 2.77 translates into a 277% increased risk for HZ,” Dr. Yawn says. “For PHN, one of the most devastating complications of HZ, the ratio was 1.07, or a 7% increase, which was not statistically significant. What that means is that patients with HZ may not have any greater risk
for PHN, but that almost three times as many will get HZ and then be at risk for PHN (Figure).”

Future studies are needed, according to Dr. Yawn, to help elucidate the detailed mechanisms of the increased risk for HZ in those with COPD and assess the impact of HZ on patients with COPD, including the potential for links to acute COPD exacerbations. She also recommends repeat studies, once vaccine uptake has increased, to confirm that increased risk for HZ can be prevented with appropriate vaccinations.

Survey Points to Need for HCP Education

“Before our survey-based study of HCPs, no information had been published about how often HCPs were recommending HZ vaccination to patients with COPD,” says Dr. Yawn. “We found that many opportunities exist for increasing ACIP-concordant vaccination recommendations by HCPs for this population. A simple, 5-minute video about the burden, increased incidence, and appropriate prevention options enhanced by a 1-minute patient testimony increased HCP-reported future intent to recommend HZ vaccination to patients with COPD.”

Dr. Yawn and colleagues conducted an online survey of pulmonologists (N=258), family physicians (FPs; N=229), nurse practitioners (NPs; N=250), and physician assistants (PAs; N=283). Part 1 of the survey collected demographic data about the HCPs’ current practice recommendations for HZ, influenza, and pneumococcal immunizations among their patients with COPD. Part 2 was completed by respondents who did not strongly encourage HZ vaccination or whose recommendations were not concordant with current ACIP recommendations.

“In our study, 41.1% of pulmonologists, 63.3% of FPs, 59.2% of NPs, and 55.1% of PAs were not likely to strongly agree that HZ, PHN, and HZ eye complications caused a sufficient enough burden in patients with COPD to strongly recommend the HZ vaccine,” says Dr. Yawn. “Further, 87.3% of FPs, 62.4% of NPs, 59.7% of PAs, and 48.1% of pulmonologists were not likely to recommend or administer the ACIP-preferred two-dose recombinant vaccine to patients with COPD. We need to do better because HCP vaccine recommendations are one of the most important factors in increasing vaccine uptake.”