GP knowledge gaps regarding Zostavax use in immunocompromised people remain concerning, study finds

New research has found notable knowledge gaps continue to exist among Australian general practitioners (GPs) regarding live attenuated zoster vaccination of immunocompromised people.

While the vaccine is safe, its use is contraindicated in immunocompromised people because the virus from the vaccine can cause serious disseminated infection. There have been three Zostavax-related deaths in immunocompromised people between 2017 and 2020 in Australia.

The research, led by the National Centre for Immunisation Research and Surveillance (NCIRS), used an online survey to assess the knowledge of GPs regarding Zostavax. GPs were asked to respond to five clinical scenarios testing their knowledge of Zostavax contraindications, and the proportion of correct answers ranged from 25% to 82% across all scenarios.

“Continued knowledge gaps among GPs are concerning. More work needs to be done to improve awareness of Zostavax recommendations for immunocompromised people,” said Dr Frank Beard, Associate Director at NCIRS and Associate Professor at the University of Sydney, who is a co-author of the study.

“GPs should refer to information in the ATAGI Statement on the Clinical Use of Zoster vaccines in Older Adults in Australia and use the pre-vaccination screening tool. If unsure whether Zostavax use is appropriate, for example, in people with mild immunocompromise, they should talk to an immunisation specialist or the patient’s treating physician before administering the vaccine,” he said.

This is the second such survey of Australian GPs; the first conducted in late 2017 (around 1 year after the vaccine program was introduced) also identified significant knowledge gaps. After the Therapeutic Goods Administration issued another safety alert in July 2020 following the death of an immunocompromised person, NCIRS researchers launched this survey to assess if there had been any change in the knowledge of GPs between 2017 and 2020. 

Zostavax was introduced on the National Immunisation Program in November 2016 for people aged 70 years, with a catch-up program for adults aged 71–79 years funded until October 2023. 

A non-live recombinant subunit zoster vaccine, Shingrix, is now available in the private market and provides an alternative, especially for immunocompromised patients.

Read the full study here

Access the Live shingles vaccine (Zostavax) screening for contraindications tool