After reading “Battling shingles: Fine-tune your care” (J Fam Pract. 2011;60:13-17), I would like to make the following points: First, in cases of trigeminal nerve involvement of herpes zoster (HZ), family physicians can start antiviral treatment without immediate referral to an ophthalmologist. Referral is only indicated in the presence of the Hutchinson sign in the early phase, visual complaints, and/or an unexplained red eye. Since vision-threatening ophthalmic complications usually do not develop in the first week after onset of skin rash, ophthalmic zoster is generally not an emergency. It is important to emphasize that antiviral medication should be started as soon as possible, independent of age and ophthalmic condition.1
Second, Lu et al demonstrated that the major barrier to physician use of the zoster vaccine is concern about reimbursement.2 In a Dutch primary care study, however, my colleagues and I identified other key factors. We assessed the willingness of elderly patients to accept a free offer of HZ vaccination, to be given with their annual influenza vaccine. Only 39% of those who received this offer accepted HZ vaccination, whereas compliance with the flu vaccine was 76%. The major determinants of patients’ failure to agree to HZ vaccination were perceived lack of recommendation by the physician, unwillingness to comply with the physician’s advice, and the perception of low risk of contracting HZ.3
These results demonstrate that taking away the reimbursement barrier to HZ vaccine may not lead to a desirable zoster vaccination rate. To increase the acceptance of zoster vaccination, physicians and patients need more information about HZ’s impact on the elderly and the vaccine’s effectiveness and cost effectiveness.
Wim Opstelten, MD, PhD
Utrecht, The Netherlands