Evidence of increasing frequency of herpes zoster management in Australian general practice since the introduction of a varicella vaccine

Objectives: To assess whether the management rate of herpes zoster (HZ) in Australian general practice has changed since varicella vaccines became available; and to ascertain the mean age of patients attending general practice for HZ management, to assist with planning of vaccination to prevent HZ in older Australians. Design, setting and participants: Retrospective analysis of data for the period April 1998 to March 2009 on 1 078 671 (weighted) management encounters with consecutive patients of 10 885 general practitioners who participated in the BEACH (Bettering the Evaluation and Care of Health) national cross-sectional survey. Main outcome measures: Number of encounters for management of HZ (shingles) and of varicella (chickenpox); age of patients presenting for HZ management. Results: Regression analysis indicated a significant rise in the HZ management rate over the study period, with an average annual increase of 0.05 per 1000 encounters (P<0.01). The management rate for varicella decreased significantly from 2.01 per 1000 encounters in 1998–1999 to 0.58 per 1000 in 2008–2009. Mean age calculated for each year of the study varied between 10.2 and 15.3 years for patients with varicella, and between 57.5 and 64.1 years for patients with HZ. Conclusions: There has been a significant rise in the HZ management rate and a decrease in the varicella management rate in Australian general practice over the period 1998–2009. Introduction of vaccination for HZ prevention at age 60 years should be considered, although addition of this vaccination to the existing schedule for vaccination at age 65 years is also likely to be beneficial and may be more pragmatic.