First Responder Online Dementia Training

KARK Channel 4 (NBC) recently featured the UAMS Arkansas Geriatric Education Collaborative in a video story about our recently-launched Online First Responder Dementia Training. You can check out KARK’s story about our online training, featuring interviews from UAMS Police Chief Barrentine and AGEC’s Laura Spradley, by clicking here.

To learn more information or to register for our free Online First Responder Dementia Training, click here.

 

 

 

UAMS Arkansas Geriatric Education Collaborative Awarded $3.7 Million by Health Resources and Services Administration

UAMS Arkansas Geriatric Education Collaborative, Clinton School Address Opioid Crisis

KATV News Story: https://katv.com/news/local/town-hall-medical-professionals-address-opioid-use-for-chronic-pain

Arkansas Democrat-Gazette News Story : https://www.arkansasonline.com/news/2019/apr/13/opioid-struggles-focus-of-forum-2019041/

Facebook: https://www.facebook.com/UAMShealth/videos/380861315843726/

Twitter: https://twitter.com/ProgramsUACS/status/1117867656990744576

 

UAMS Arkansas Geriatric Education Collaborative Awarded $3.7 Million by Health Resources and Services Administration

About this Blog:  AGEC Geriatric Student Scholars provide a first hand account of their experience as a Geriatric Student Scholar at the UAMS Arkansas Geriatric Education Collaborative. 

My name is Samantha Pennington, and I am a 2019 Geriatric Student Scholar for the UAMS Arkansas Geriatric Education Collaborative (AGEC). I am from the small town of Poyen, Arkansas. In 2016, I graduated from Henderson State University with a Bachelor of Science in biology and a minor in chemistry. Currently, I am a third-year pharmacy student at the UAMS College of Pharmacy. I work at Community Care RX Pharmacy in Malvern, AR and Arkansas Children’s Hospital in Little Rock, AR.

I have always loved the geriatric population. I have been blessed with awesome grandparents and elders in my life! Older adults are complex patients with many aspects of care to consider. When I graduate, I hope to be a resource that geriatric patients in my community can turn to. To learn to better care for this population, I enrolled in a Geriatric Therapeutics course with Dr. Lisa Hutchison last semester. We helped lead a Medicare Part D clinic at the UAMS Donald W. Reynolds Institute on Aging. During this clinic, we met with geriatric patients and helped them to choose the best insurance plan option. We also participated in an “Adopt-A-Patient” assignment and were given a patient to follow throughout the semester. My partner and I went to our patient’s house to visit with her three to four times over the semester. We were able to get to know her and her family. She told us about her life story, shared lessons she learned through the years, and always made us laugh. I thoroughly enjoyed sharing time with my patient. We discussed her medical conditions, therapy, and even quizzed her on her medications. She was a great sport and allowed us to perform physical assessments and mental state examinations. This course expanded my interest in this population and helped me to discover that I love the field of geriatrics!

Since January, I have had the pleasure of attending two academic Geriatric Grand Round presentations and participating in three community events. The grand rounds were “Treatment for Alzheimer’s Disease “Inside & Outside the Box” and “To Urinate or Not to Urinate: That is the Problem.” The community events were Hope for the Future Caregiver Workshop, Diabetes Empowerment Education Program, and Alzheimer’s Experience: Take a Walk in Their Shoes. All of these events helped to expand my knowledge of common geriatric conditions and disease states. It is so important for health professionals to learn how to provide appropriate care for the geriatric population. There are many aspects to consider, from complex disease states to geriatric syndromes such as delirium, polypharmacy, and malnutrition. Health care providers must learn how to manage these disease states, while also considering the pharmacokinetics/pharmacodynamics of treatment. It is also important to be able to break-down complex concepts to each patient so that they can provide the best care for themselves. I have enjoyed learning about this population and having the opportunity to meet some great patients. I can’t wait to learn more as I continue throughout my pharmacy school education!

About the program: The purpose of the Student Scholars program (sponsored by AGEC) is to increase health professions students’ interest and exposure to older adults, to improve knowledge of older adults and the specialized care they need and to promote interprofessional collaboration among health professions students. Click here to learn more about the AGEC Geriatric Student Scholar Program.

 

It is with great pleasure that the Arkansas Geriatric Education Collaborative (AGEC) announces its 2019 selection for the Geriatric Student Scholars program – Samantha Pennington, a third-year College of Pharmacy student; Taylor Bennett, a third-year College of Medicine student, Holly Bennett, a second-year College of Health Professions student and Larreasha Adams from the College of Nursing Adult-Geriatric Primary Care Program.

The purpose of the Student Scholars program (sponsored by AGEC) is to increase health professions students’ interest and exposure to older adults, to improve knowledge of older adults and the specialized care they need and to promote interprofessional collaboration among health professions students.

We are so excited to announce the Geriatric Student Scholars for FY 2019 to support emerging health professionals education and participation surrounding specialized needs for older adults, and to foster interprofessional collaboration in academic and clinical geriatrics. The goal of the Geriatric Workforce Enhancement Program (GWEP) is to enhance the quality of health care for elderly Arkansans through research, education and training. The Geriatric Student Scholars program is an excellent way to achieve this goal and mentor future healthcare team members. – AGEC Director, Robin McAtee, Ph.D., RN., FACHE

UAMS’ Arkansas Geriatric Education Collaborative is a program of the University Of Arkansas for Medical Sciences – Department of Geriatrics. The collaborative is funded by a Health Resources and Services Administration grant of $3.2 million for a Geriatrics Workforce Enhancement Program.

by Heather Mercer
Executive Director, ImmunizeAR

 

Last flu season was brutal. In Arkansas, 227 people died from influenza, including 171 adults who were 65 and older, and we had a record number of flu-related hospitalizations. Arkansans aren’t doing a great job getting flu vaccines. According to the CDC, only 46 percent of the general population got a flu vaccine during the 2016-17 season.¹ One reason for the low vaccination rate in Arkansas may be a lack of patient understanding of the efficacy of the flu vaccine. The media didn’t help this last year when they wrongly reported the U.S. flu vaccine was only 10 percent effective based on Australia’s flu season.  Vaccinations for other diseases work so well that people may have unrealistic expectations for the flu vaccine.  Some individuals choose not to get the flu shot because of the evidence that the flu vaccine isn’t 100% effective in preventing the flu. However, if someone receives the flu shot and still gets the flu, the flu shot can reduce the severity of their symptoms and help them stay out of the hospital. A better understanding of this information could help increase people’s willingness to accept the vaccine.

To improve the numbers of Arkansan’s getting the flu vaccine, The Arkansas Immunization Action Coalition (ImmunizeAR) has available for distribution, by downloading and printing from their website, a Flu Prevention Workshop toolkit, “Let’s Talk About the Flu.”  The toolkit provides all the materials needed for a church or a community-based organization to host a one-hour long interactive workshop in plain language. It is designed to help increase flu vaccinations among adults, including older adults. The purpose of the workshop is to help community members learn about the flu in an easy to understand manner, provide information about the flu vaccine, address questions and concerns about the flu vaccine in a supportive environment, and if possible provide the flu vaccine at the end of the workshop with the assistance of a pharmacist. The toolkit is available on the ImmunizeAR website in English and Spanish https://www.immunizear.org/let-s-talk-about-the-flu .

It is important for everyone over the age of six months to get a flu vaccine every year. For older adults and others who are at high-risk of complications, a flu vaccine can reduce hospitalizations by as much as 70 percent and deaths by 85 percent.² It is the best way to protect you and your family.

The CDC recommends getting a flu vaccine before flu begins spreading in the community. It takes about two weeks after vaccination for antibodies that protect against flu to develop in the body. It is recommended people get a flu vaccine by the end of October. The flu vaccine is available at most pharmacies and physician offices and the Arkansas Department of Health that started their mass flu clinics at the end of September. You can go to this link to find a mass flu clinic in your area: https://www.immunizear.org/news-and-events-1

ImmunizeAR is a non-profit organization dedicated to improving vaccination rates for all Arkansans through education, advocacy, and statewide partnerships. If you would like more information about the flu prevention toolkit or ImmunizeAR, please email heather@immunizear.org.

 

1. FluVaxView 2016-2017 Flu vaccination rates for persons aged 6 months and older. https://www.cdc.gov/flu/fluvaxview/reportshtml/trends/index.html
2. https://www.cdc.gov/flu/about/disease/65over.htm

by Robin McAtee, PhD, RN, FACHE, Director, Arkansas Geriatric Education Collaborative at UAMS

The AGEC received news earlier this year that we might receive a 4^th year of funding from HRSA without rewriting for the grant!  We are optimistic as a federal budget has been approved and the GWEPs are still included.  We now patiently await news from HRSA!

While we wait on that, we are busy with programs all over the state! Our health professional programs are consistently reaching over 100 healthcare professionals for each program as we have expanded our coverage with live and webinar formats!  This spring we are exploring the new Shingles vaccine as well as other vaccines for adults.  Please join us on May 8^th from 11-1 in the Rahn Auditorium for that event! We have also worked with our partner in educating direct care workers on reformatting the certified nurse assistant curriculum from 116 hours to 91 hours, thus increasing our capacity and making the program more competitive within many of our diverse communities.   We are also reaching out into the communities in an effort to touch more family caregivers with education; especially surrounding dementia care.  We have had several dementia family care giver workshops this past fall and winter and have many more scheduled this spring!  Other popular programs include activity and fall prevention related programs such as A Matter of Balance, Tai Chi, and Ageless Grace.

For information on any of our programs and our partnered programs, please explore our website!

 

By Gretchen Gibson, DDS, MPH

During this month of celebrating Veteran’s Day, it seemed appropriate to recognize another continued service of our Veterans, beyond their military time. The Million Veteran Program (MVP) is a research program designed to better understand how genes affect health and illness. Data collected as part of the MVP will help enhance disease screening, diagnosis and prognosis for both Veterans and all Americans.
Data collection began in 2011 at various VA hospitals throughout the United States. To date, the MVP has over half a million Veterans who have volunteered and enrolled. Therefore, this is now the world’s largest genomic database, or genetic biorepository. Veterans who volunteer are asked to complete a short questionnaire and donate one vile of blood. This genetic data is linked to their questionnaire and the VA electronic health record to aid in the development of new diagnostic tests, precision or targeted medications, precision therapies and to look at the link of military exposures to genetic susceptibilities to aid in novel approaches to treating these conditions.
Older Veterans are playing a key role in this research. In 2016, Gaziano et al looked at the characteristics of the Veterans who had volunteered thus far. Over 70% of the volunteers were age 60 or over, with a mean age of 64.4 (+13.4) years. An impressive database available to help address many of the chronic issues affecting or older patients.

Currently, there are 15 scientific projects that have been approved to utilize this data for further study. Eight of the ongoing projects include:
• Gulf War Illness risk factors
• Posttraumatic stress disorder risk factors
• Functional disability in schizophrenia and bipolar illness
• Genetic vulnerability of sustained multi-substance use in MVP
• Genetics of cardio-metabolic diseases in the VA population
• Pharmacogenomics of risk factors and therapies outcomes of kidney disease
• Cardiovascular disease risk factors, prevalent cardiovascular disease and genetics in the MVP
• Genetic risk for age-related macular degeneration in diverse Veteran populations

As a dentist in the VA, I have had the privilege to serve America’s Veterans for over 25 years. As the local site investigator for the MVP program at the VA hospital in Fayetteville, AR, I am humbled to see Veterans again stepping up to volunteer their time and information to help improve the health of other Veterans and all Americans. Again, another reason to thank our Veterans.

The Million Veterans Program is accepting volunteers at both the VAs in Fayetteville and Little Rock, Arkansas. If you are a VA-enrolled Veteran, or know a VA-enrolled Veteran who would like to participate, please call the MVP Information Center toll-free at 866-441-6075 for information or to set an appointment at either VA.

References:

Gazianno JM, Concato J, Brophy M. et al. Million Veteran Program: A mega-biobank to study genetic influences on health and disease. J of Clin Epidomiol.2016;70:214-23.

by LaVona Traywick, PhD, University of Central Arkansas and Terry Griffin, PhD, Kansas State University

Society as a whole is aging and there are not enough health care providers in any health related field, including Occupational Therapy, to meet the current or expected needs of the senior adult population (Eldercare Workforce Alliance, 2011). According to the Administration for Community Living (2016), the senior adult population makes up 14.5% of the population in the United States. This number is expected to increase to 21.7% by 2040. Results from the National Ambulatory Medical Care Survey (Ashman, 2015) indicated that senior adults aged 65 and over visited medical offices more than twice the rate than the remaining groups (adults aged 18–64 and children under age 18 years). The current literature shows an increasing need for medical health professionals to work with the aging population.

A study was conducted with the first year, first semester students of the University of Central Arkansas Occupational Therapy graduating class of 2018 to determine their knowledge of aging prior to beginning studies. Once IRB approval was obtained, the modified version of Erdman Palmore’s “Facts on Aging Quiz” (Breytspraak & Badura, 2015) was deployed online via Qualtrics software. Using this convenience sample of 48 students, a 100% response rate was achieved consisting 43 females and five males, with a mean age of 24. Descriptive statistics showed that nine participants want to work in geriatrics, four want to work with adults, 16 want to work in pediatrics, five want to work with all populations, five want to work with special populations (such as spinal cord injuries), and nine were undecided.
The student’s knowledge of aging was poor, average of 33/50 (66%). A variety of analysis methods were applied to the data, but in summary the knowledge about senior adults was poor regardless of the students’ preferred population, year of birth, undergraduate degree, or duration of testing.

There was no significant difference in the test scores for the students who wanted to work in geriatrics as compared to any other population. It was hypothesized that students who desired to work with the senior adult population would have a greater knowledge of aging, but this was not the case. This fact is disconcerting because these students are not understanding the difference between normal aging and the disease process. The data results have brought a heightened awareness to the need to teach aging throughout the entire lifespan, including end-of-life issues.

Additionally, one-third of the entering OT class desires to work with solely pediatric populations. This is of concern due to the increasing need of therapists with the geriatric population. A previous study by Carmel, Cwikel and Galinsky (1992) showed that increasing knowledge alone as indicated by their scores on Palmore’s Facts on Aging Quiz was not enough to change attitudes about aging or the desire to work with the senior adult population. When knowledge of aging is not enough to encourage students to want to work with senior adults, it is even more important for course instructors to create opportunities for students to interact directly with senior adults. As there are limited amount of fieldwork options for students enrolled in therapy programs in general, opportunities for positive interactions with senior adults can be accomplished through Service Learning avenues.

In general, therapy programs in graduate schools are striving to teach as much material as possible in a condensed amount of time to stay competitive. Given no significant difference in test scores based on undergraduate degree, more emphasis needs to be placed in gerontological literacy in undergraduate programs across all disciplines. It could also be argued that prerequisites for incoming therapy students include a basic gerontology or lifespan development course.

In conclusion, the students’ knowledge of aging was less than desired and their intentions to work with senior adults was relatively low compared to other groups. It would be beneficial to the current students as well as the older patients if educators could incorporate more positive senior adult interaction opportunities along with teaching on aging. Future studies should look at other ways besides knowledge gain to change attitudes towards aging. Future studies should also look at the benefit of undergraduate education in gerontology for preparation of health care workers.

References:
1. Administration of Community Living. (2016). Administration on aging. Retrieved from http://www.aoa.acl.gov/Aging_Statistics/index.aspx

2. Ashman, J.; Hing, E.;Talwalkar, A. (2015) Variation in Physician Office Visit Rates by Patient Characteristics and State, 2012: NCHS Data Brief No. 212, September 2015. Retrieved fromhttp://www.cdc.gov/nchs/data/databriefs/db212.htm
3. Breytspraak, L. & Badura, L. (2015). Facts on aging quiz (revised; based on Palmore (1977;1981). Retrieved from http://info.umkc.edu/aging/quiz/.

4. Carmel, S; Cwikel, J.; Galinsky, D. (1992) Changes in Knowledge, Attitudes, and Work Preferences Following Coures I Gerontology among Medical, Nursing, and Social Work Students. Educational Gerontology, Vol. 18, Issue 4
Eldercare Workforce Alliance. (2011). Geriatrics workforce shortage: A looming crisis for our families. Retrieved from https://eldercareworkforce.org/research/issue-briefs/research:geriatrics-workforce-shortage-a-looming-crisis-for-our-families

by Shanon Brantley, MCD, CCC-SLP, Arkansas State University

Communication is a complex task. Communication between healthcare professionals and patients often increases this complexity due to reduced or poor health literacy skills of patients. Health literacy refers to “the degree to which individuals can obtain, process, and understand basic health information and services they need to make appropriate health decisions” (Healthy People 2010). Approximately one-third of adult Americans, including nearly 820,000 Arkansans (37 percent) are affected by low health literacy (Bakker, Koffel, Theis-Mahon, 2017 and Coleman, Peterson-Perry, & Bumsted, 2016). Even more staggering is that 70 percent of older adults (65 yrs. and older) in the United States have low health literacy skills (Kobayashi, Wardle, Wolfe & Wagner, 2015 & Chesser, Woods, Smothers, & Rogers, 2017). The impact of low health literacy is associated with increased hospitalizations, increase use of health services, increase in medication errors, reduced compliance with health care instructions, reduced use of preventive health behaviors, increased medical expenses, and an increase in mortality rates (Hadden, 2015, National Network of Libraries of Medicine, Toronto & Weatherford, 2015).

Low health literacy in older adults is often associated with age-related changes, such as a decline in cognitive ability, hearing or vision loss, and factors of socioeconomic status (Chesser et al., 2016). However, the consequences of low health literacy in older adults are particularly crucial due to a need for more frequent health information and services because of their increasingly complicated health issues (Kobayashi et al., 2015). Due to the large population of individuals with low health literacy and its devastating effects, it is essential that healthcare professionals have adequate awareness and understanding of health literacy issues (Atcherson, Zraick, & Hadden, 2013, Coleman, Hudson, & Maine, 2013) to assist patients/clients make good healthcare decisions for themselves (Greenwood, 2017).

Unfortunately, Coleman (2011) reports that healthcare professionals have less than adequate education in the principles of health literacy. To address this issue, educators of health professions should incorporate health literacy into their educational curriculum (Hadden, 2015). However, healthcare professionals who have already “completed their education will need accessible educational programs to ensure they have the skills to identify and educate patients with limited health literacy” (Jukkala, Deupree, & Graham, 2009, p. 301). The critical need for healthcare professionals to play a role in recognizing and addressing low health literacy of their patients/clients is also evident in a statement by the Joint Commission (https://www.jointcommission.org/about_us/history.aspx) which “requires that patients not only receive but also understand information that is relative to their medical condition and care” (DeMarco & Nystrom, 2010, p. 295).

Although the U.S. Department of Health and Human Services (2010) developed the U. S. National Action Plan to Improve Health Literacy, there are currently no widely accepted guidelines on health literacy education for healthcare professionals (Coleman, Hudson, & Maine, 2013). However, some topics of health literacy that healthcare professionals may focus improvements on include: spoken communication and written communication of healthcare professionals, self-management and empowerment of patients/client, and support systems for healthcare professionals and patients/clients. Each topic is important and should be addressed to improve patients’ and clients’ health literacy. Although there are no well-established guidelines for health literacy education for healthcare professionals, there are several health literacy training opportunities for healthcare providers available online. Two common and free health literacy education resources are provided below.

The Centers for Disease Control and Prevention offers a one-hour online continuing education course accredited by the Accreditation Council for Continuing Medical Education (ACCME) titled, Health Literacy for Public Health Professionals. This course is free of charge and can be found at the following link: https://www.train.org/cdctrain/course/1057675/.
The Agency for Healthcare Research and Quality (AHRQ) division of U.S. Department of Health & Human Services offers evidence-based health literacy guidance to adult and pediatric practices through the AHRQ Health Literacy Universal Precautions Toolkit, 2nd edition. This toolkit offers 21 tools for improving health literacy, appendices with over 25 additional health literacy resources, and a quick start guide. This guide is available to download at the following link: https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.html

Health literacy can significantly affect the health status of patients and has consequently become a national concern (Hester & Stevens-Ratchford, 2009). In order to provide the best care possible for our growing population, health professionals need an appropriate understanding of key concepts affecting their care such as health literacy. Additional health literacy education and training resources are provided below to assist in improving healthcare professional’s awareness and understanding of low health literacy:

● Center for Health Literacy at University of Arkansas for Medical Sciences. http://healthliteracy.uams.edu/
● U.S. Department of Health and Human Services, Office of Center for Disease Control and Prevention – National Action Plan to Improve Health Literacy. https://health.gov/communication/hlactionplan/pdf/Health_Literacy_Action_Plan.pdf
● Health Literacy Tool Shed – http://healthliteracy.bu.edu/
● U.S. National Library of Medicine – Health Literacy Information Resources. https://www.nlm.nih.gov/services/queries/health_literacy.html

References:
1. Agency for Healthcare Research and Quality. (2017). AHRQ health literacy universal precautions toolkit. Retrieved from https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.htmll
2. Atcherson, S., Zraick, R., Hadden, K. (2013). A need for health literacy curriculum: Knowledge of health literacy among US audiologists and speech-language pathologists in Arkansas Education for health, 26(2), p. 85-88.
3. Bakker, C. J., Koffel, J. B., & Theis-Mahon, N. R. (2017). Measuring health literacy of the upper midwest. Journal of the Medical Library Association, 105(1), 34-43.
4. Chesser, A. K., Keene Woods, N., Smothers, K., & Rogers, N. (2016). Health literacy and older adults. Gerontology and Geriatric Medicine, 5. Retrieved from https://doi.org/10.1177/2333721416630492
6. Coleman, C. (2011). Teaching health care professionals about health literacy: A review of the literature. Nursing Outlook, 59(2), 70–78. Retrieved from http://doi.org/10.1016/j.outlook.2010.12.004
7. Coleman, C. A., Hudson, S., & Maine, L. L. (2013). Health literacy practices and educational competencies for health professionals: A consensus study. Journal of Health Communication, 18(sup1), 82–102. Retrieved from http://doi.org/10.1080/10810730.2013.829538
8. Coleman, C. A., Peterson-Perry, S., & Bumsted, T. (2016). Long-term effects of a health literacy curriculum for medical students. Family Medicine, 48(1), 49–53.
9. DeMarco, J., & Nystrom, M. (2010). The importance of health literacy in patient education. Journal of Consumer Health on the Internet, 14(3), 294–301. Retrieved from http://doi.org/10.1080/15398285.2010.502021
10. Greenwood, M. (2017). Arkansas Blue Cross launches health literacy campaign. Arkansas Blue Cross and Blue Shield. Retrieved from https://www.bcbs.com/news/press-releases/arkansas-blue-cross-launches-health-literacy-campaign
11. Hadden, K. B. (2015). Health literacy training for health professions students. Patient Education and Counseling, 898(7), 918-920.
12. Jukkala, A., Deupree, J. P., & Graham, S. (2009). Knowledge of limited health literacy at an academic health center. Journal of Continuing Education in Nursing, 40(7), 298-302-304, 336. http://doi.org/10.3928/00220124-20090623-01
13. Kobayashi, L. C., Wardle, J., Wolf, M. S., & von Wagner, C. (2015). Cognitive function and health literacy decline in a cohort of aging English adults. Journal of General Internal Medicine, 30(7), 958–964. Retrieved from http://doi.org/10.1007/s11606-015-3206-9
14. Toronto, C. E., & Weatherford, B. (2015). Health literacy education in health professions schools: An integrative review. Journal of Nursing Education, 54(12), 669–676. Retrieved from http://doi.org/10.3928/01484834-20151110-02
15. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National action plan to improve health literacy. Washington, DC: Author.

by Ashley McPhee, PharmD Candidate and Lisa Hutchison, PharmD, MPH, University of Arkansas for Medical Sciences  (UAMS) College of Pharmacy

Herpes zoster, commonly known as shingles, is a viral infection that causes a painful rash. The rash usually occurs on one side from the middle of the back toward the chest, but it can occur in other areas as well. Shingles is the result of reactivation of the existing but undeveloped varicella zoster virus (VZV). This is the virus that causes chickenpox.1 Nearly all older adults have the VZV dormant in their nervous system because they were exposed to chicken pox as a child.2 Protection from reactivation is dependent on cell-mediated immunity. This type of immunity decreases as we age, if we have certain diseases, or medications. An example of disease and medications include Human immunodeficiency virus (HIV) and high dose steroid treatment. The average age for shingles to occur is about 64 years.1
Current 2017 Centers for Disease Control (CDC) guidelines recommend shingles vaccination. This vaccine (Zostavax©), is a live, attenuated vaccine. This means that the vaccine is living and produces disease, but it has been weakened so that it produces immunity but not illness.3 Currently, the CDC recommends that adults ages 60 years and older get one dose of the vaccine. They should get it even if they have had shingles before. Since the vaccine is live, patients who are pregnant, have severe immunodeficiency, or on systemic immunosuppressive therapy should not receive it. In addition, patients with malignant conditions such as those that affect bone marrow or patients with HIV and a CD4+ T-lymphocyte count less than 200 cells/µl should also not receive the vaccine.4 These individuals may not be able to mount a response to the virus to create antibodies.

However, a new shingles vaccine (Shingrix©) will soon be available. This vaccine is a non-live, recombinant subunit containing a piece of the Herpes zoster virus that will stimulate the immune system most efficiently. The new vaccine is given intramuscularly in two separate doses, and is indicated for patients 50 years and older. This vaccine was shown to produce the desired effect 90% of the time, across all age groups.2 The previous vaccine was only about 50% effective.3 t In October 2017 the CDC’s Advisory Committee on Immunization Practices  (ACIP) voted in favor of recommending this new vaccine for patients who are 50 years and older even if they have received Zostavax previously. They also determined that Shingrex© would be preferred over Zostavax© for these individuals.2  One concern is that the trials with this vaccine did not include patients who were immunocompromised.5 The vaccine is not live, so this should not necessarily be a contraindication for vaccination. However, ACIP does mention immunocompetence as part of their requirement for recommendation at this time.2 It is possible the recommendation will change based on post-marketing data after the general population has been receiving the vaccine. For now, it provides a great alternative vaccine for patients who were previously not eligible due to age, providing more effect.

References:
1. Dworkin, R. H., Johnson, R. W., Breuer, J., et al. Recommendations for the Management of Herpes Zoster. Clinical Infectious Diseases. 2007; 44(1):S1–S26.
2. Shingrix approved in the US for prevention of shingles in adults aged 50 and over. 2017. https://www.gsk.com/en-gb/media/press-releases/shingrix-approved-in-the-us-for-prevention-of-shingles-in-adults-aged-50-and-over/
3. Shingles (Zoster): Questions and Answers Information about the disease and vaccine. http://www.immunize.org/catg.d/p4221.pdf
4. Immunization Schedules. 2017. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html
5. Highlights of Prescribing Information. 2017. https://www.gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_Information/Shingrix/pdf/SHINGRIX.PDF