Jill Sederstrom

The number of adults getting the shingles vaccine is on the rise, but there is still significant room for improvement, according to 

A brief from the National Center for Health Statistics showed that the percentage of adults over the age of 60 years old who received the shingles vaccine has jumped from 6.7% in 2008 to 34.5% in 2018, suggesting positive progress in recent years to improve vaccination rates.

But although the figures have continued to rise, the majority of older adults still haven’t been vaccinated.

“I definitely think there is room for improvement,” Mitchel C. Rothholz, RPh, MBA, chief of governance and state affiliates of the American Pharmacists Association (APhA) and executive director for the APhA Foundation told 

Rothholz said one of the biggest obstacles in recent years has been the accessibility of the vaccine for many pharmacies and patients.

Although Merck offered the first shingles vaccine, Zostavax, in the United States beginning in 2006, it stopped selling its product in July after the more effective vaccine Shingrix began to take hold of the market, according to 

Shingrix, which was approved in late 2017, has been found to be 97% effective in adults ages 50 to 69, but it has also been in short supply.

“I think the rate would have probably been higher if there wasn’t a supply issue that manufacturers have just really come out of,” Rothholz said. “I don’t think we’ve seen the maximum potential with the vaccine delivery there.”

Another barrier, he said, has been payment policy. Under Medicare, the vaccine is covered under Medicare Part D but prescription drug plans “have different copays that people are having to pay to get that and some of those are high copays and become a barrier, especially as things in the economy change,” he said.

According to the data from the National Center for Health Statistics brief, there are still significant differences in immunization rates based on race, education level, and socioeconomic status.

The data, which was taken from the National Health Interview Survey, found that non-Hispanic white adults were much more likely to get the vaccine and had a rate of 38.6% compared with non-Hispanic Black adults (18.8%) and Hispanic adults (19.5%).

Adults were also more likely to get the vaccine if they had a high school diploma or GED compared with those adults with less education (39.9% vs 21.1%, respectively).Those adults who were considered poor based on their family income level were also less likely to receive the vaccine (20.4%) compared with those who were above the income category (38.4%). Men and women were equally likely to have gotten the vaccine (33.5% and 35.4%, respectively).

According to Rothholz, pharmacies have been the “primary provider” administering the vaccine and their role is only expected to grow now that the vaccine has become more accessible.

“They’ve been managing the best they can with the limited resources that we have,” he said of pharmacies.

Now that more vaccines are expected to be available, Rothholz said it is important that pharmacists talk with patients about any potential reactions associated with the vaccine, particularly now that people are more in-tune with their health because of the coronavirus pandemic.

It’s important they know which symptoms could be attributed to the vaccine and which symptoms might suggest a more serious health concern, he said.

“This is one of the tools in our immunization tool kit to protect the public and even in this time of COVID people need to be protected,” he said.

1. CDC. National Center for Health Statistics. Shingles Vaccination Among Adults Aged 60 and Over: United States, 2018. July 2020. 

https://www.cdc.gov/nchs/products/databriefs/db370.htm

2. Galewitz P. Shingles Vaccination Rate Soars But Leaves Many Behind. 

. Published July 9, 2020. Accessed August 31, 2020. https://khn.org/news/shingles-vaccination-rate-soars-but-leaves-many-behind/.

Articles

New data show that the percentage of adults over the age of 60 years old who received the shingles vaccine has jumped from 6.7% in 2008 to 34.5% in 2018. 

US Shingles Vaccination Rate Jumps, But There Is Still Room for Improvement

Results of a new study on immunization rates and current barriers at Wisconsin pharmacies demonstrated that collaborating with physicians could provide significant benefits to patients.

, reported the most common vaccines administered in pharmacy settings, identified the biggest barriers to increasing vaccination rates in the pharmacy setting, and stressed the importance of collaboration with other medical providers.

“Having physicians and colleagues as allies is essential,” lead author Philip C. Berce, PharmD, told 

Investigators used data from the Wisconsin Immunization Registry to determine the number of vaccinations provided to patients who were over the age of 6 years old from July 2017 to July 2018.

According to the study, 39% of zoster vaccines and 20% of influenza vaccines were administered in pharmacy settings across the state. Pharmacies were responsible for the lowest proportion of vaccine doses—at just 0.2%--for the human papillomavirus (HPV) vaccine.

Although the majority of pharmacies (84%) reported stocking influenza vaccines, just 21% reported having the HPV vaccine in stock.

The study also used survey data from 236 Wisconsin pharmacists who were asked about their attitudes on vaccination and the biggest barriers they face. 

Berce said the biggest barriers most pharmacists reported were related to billing and reimbursements.

“Despite the barriers, community pharmacies have significant potential to address vaccination gaps,” the study’s authors wrote. “Physicians, patient and legislative bodies are generally well-accepting of pharmacists as immunizers. Pharmacists, in order to be fully utilized as immunizers, must engage in active communication with patients and be willing to collaborate with physicians.”

Berce said pharmacists can work to overcome existing barriers by working with patients to advocate to their insurer and adopting patient-centric approaches, where patients are able to choose where and when they want vaccinations rather than being provider-centric.

“Our team is a collaboration between a school of pharmacy, endowment through a medical school, and a state pharmacy association—given what we are seeing at the national level, I’m thankful for our collaborative ‘immunization neighborhood’ approach in Wisconsin,” he said, adding that everyone needs to work together to improve immunization rates.

Pharmacists are often the most accessible health care provider and have the potential to make a valuable impact on improving vaccination rates, he said.

To best address patient needs, Berce said some pharmacies may need to reimagine workflow to allow for more time with patients who may be interested in vaccinations.

Although the individual roles of pharmacists and physicians may differ, Berce said they “share the same goals” and are each “well-suited to address immunization issues.”

Berce PC, Bernstein RS, MacKinnon GE. Immunizations at Wisconsin pharmacies: results of a statewide vaccine registry analysis and pharmacist survey. 

https://doi.org/10.1016/j.vaccine.2020.04.043

Study On Pharmacy Vaccination Rates Encourages Collaboration With Other Medical Providers

Attention-deficit/hyperactivity disorder (ADHD) treatment options for children continue to evolve. This year, however, caregivers may face a new challenge: finding the best treatment strategy for their child during a pandemic.

“It’s pretty clear that the pandemic has created unprecedented challenges at every level of society, particularly health care,” said John Beckner, RPh, senior director of strategic initiatives at the National Community Pharmacists Association (NCPA).

The coronavirus disease 2019 (COVID-19) pandemic has created significant challenges for all children and their families, but those obstacles may be “considerably greater” for those with ADHD, Beckner said, with some students facing virtual classrooms or less access to their regular physicians.

Lea S. Eiland, PharmD, BCPS, BCPPS, FASHP, FPPA, a clinical professor and associate department head of the Department of Pharmacy Practice at Auburn University Harrison School of Pharmacy in Alabama, said parents and health care providers need to consider the child’s unique needs and struggles when determining the best care plan.

The good news, she said, is that the ADHD drug market provides multiple options in type of medication, dosageformulation, and dosage requirements. As the market grows, pharmacists can help patients get optimal results from customized regimens.

Drug treatment options for ADHD fall into 2 categories: stimulants and nonstimulants.

According to Eiland, stimulants continue to be the first-line drug class recommended for both adults and children with ADHD.

With this drug class, which includes amphetamines and methylphenidates, pharmacokinetics and dosage formulations greatly affect the medication’s distribution in the body and its efficacy, according to Eiland. “You’re seeing, I would say even in the last several years, additional products that are marketed that have longer efficacy with a 1-time dose, and we’re still continuing to see that,” she said.

Most ADHD medications require dosing in the morning, but in 2019, Jornay PM arrived on the market, signaling the first FDA-approved stimulant designed for evening dosing. The methylphenidate product is taken at night but isn’t released in the body until morning, which helps reduce the severity of symptoms early in the day.

“It’s pretty clear that the pandemic has created unprecedented challenges at every level of society, particularly health care.” 

Earlier this year, it seemed another drug to treat ADHD could soon enter the market, but in May, Sunovion Pharmaceuticals Inc announced it was withdrawing its new drug application for dasotraline, a dopamine and norepinephrine reuptake inhibitor. The drug had also been studied for treating binge eating disorder (BED).

“[Although] Sunovion considers dasotraline to be a promising, novel treatment for BED and ADHD, we believe that further clinical studies would be needed to support a regulatory approval for dasotraline in these indications,” the drugmaker said in a statement announcing the decision. The company said it did not plan to pursue further development of the drug at this time.

Sunovion seems to have hit the brakes on dasotraline, but Vallon Pharmaceuticals Inc recently announced positive data from a pilot study of Abuse Deterrent Amphetamine Immediate Release (ADAIR).

 “Results from this pilot study suggest that Vallon’s investigational immediate-release stimulant, ADAIR, may demonstrate less abuse potential than standard dextroamphetamine when manipu- lated and misused intranasally,” Timothy Whitaker, MD, a board-certified psychiatrist and Vallon’s chief medical officer, said in a statement.

If the drug continues to jump approval hurdles, it would be the first intranasal product for ADHD, Eiland said. Overall, most of the chemical entities in clinical trials focus on the adult ADHD population rather than the pediatric setting. However, in some pediatric studies, investigators are looking into the neurobehavioral effect of drug holidays—stopping medication for a brief period of time, such as during summer break or weekends—or examining the effects of certain behavioral therapy interventions, Eiland said.

As more drug formulations and options enter the market, Eiland said, the key to determining the best strategy often requires looking at the child’s own needs.

“Do they wake up with symptoms? Do they wake up and it’s hard to get them dressed, get them to school, get them to day care? Or is it that you can get them up, but they have a harder time focusing during school, during the lunch hour, afternoon hours or evenings when they come home? And so we can actually select a stimulant product that works best based on when the child needs the most control for symptoms,” she said.

Pharmacists on a health care team can talk with physicians about individual drug options, the medications’ release in the body, and even the “vast pharmacokinetic difference” between a tablet, capsule, and liquid suspension form of the drug, Eiland said.

Community pharmacists can also play a valuable role by counseling a patient or caregiver on how to administer the medication and what adverse events to watch out for, Eiland said. Pharmacists should also alert the patient’s physician if a patient is struggling with a particular dosage form or there might be an adherence concern.

As a result of the ongoing global pandemic, visits to primary care physicians and specialists are down, Beckner said, which suggests that children with ADHD and parents may not get the 1-on-1 time with the physician they had in the past.

As more accessible health care providers, pharmacists can lend a hand by answering patient questions, counseling patients and their caregivers even during refills to identify possible concerns, and helping parents navigate dosage timing.

Children adjusting to new daily schedules may be spending much more time at home than they did in the past. “Behavioral parenting strategies are taking on an even greater role as a supplement to medications,” Beckner said. Some children may head back to the classroom; others may continue with virtual learning. Parents will need to consider individual needs to decide whether a new schedule requires changes to dosage timing or when a child learning from home seems to struggle the most with symptoms.

“There are some students that thrive in the virtual setting, and there are some students that struggle in the virtual setting, and we’re just learning that. That’s going to be something to try to figure out,” Eiland said.

“As a pharmacist in the community setting, I think it’s important to be able to counsel those caregivers in the appropriate way and time to administer that medication to that patient.” 

Parents who opt for a medication holiday during summer break may also need to decide whether they want their child to resume medication dur- ing virtual learning.

In each case, experts say, pharmacists can help caregivers and children navigate the possible changes ahead. “It’s just talking with them, inquiring...checking on adherence, checking on administration, and checking on [adverse drug reactions],” Eiland said.

Sunovion discontinues dasotraline program. News release. Sunovion Pharmaceuticals Inc. May 13, 2020. Accessed July 14, 2020. 

https://news.sunovion.com/press-releases/press-releases-details/2020/Sunovion-Discontinues-Dasotraline-Program/default.aspx

Vallon Pharmaceuticals presents positive data from pilot intranasal human abuse study of its investigational abuse deterrent stimulant, ADAIR, at the American Professional Society of ADHD and Related Disorders (APSARD) Annual Meeting. News release. Vallon Pharmaceuticals Inc. January 21, 2020. 

https://www.vallon-pharma.com/press-release-index/vallon-pharmaceuticals-presents-positive-data-from-pilot-intranasal-human-abuse-study

FDA permits marketing of first game-based digital therapeutic to improve attention function in children with ADHD. News release. FDA. June 15, 2020. Accessed July 14, 2020. 

https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-first-game-based-digital-therapeutic-improve-attention-function-children-adhd

Caregivers of children with ADHD can choose from an increasing number of treatments that can be customized.

Pandemic Presents Unique Challenges for ADHD Management

, researchers used a specially developed model to estimate the regional disease burden of Japanese encephalitis (JE), a viral infection of the brain transmitted by mosquitos.

The model also helped researchers determine the effect vaccination would have in different regions to determine where vaccination efforts would make the biggest impact.

"Estimating regional burden means that it is possible to determine where the burden is high enough in order for vaccination to be considered,” researcher Hannah Clapham, PhD, MSc told 

Clapham was a mathematical epidemiologist at the Oxford University Clinical Research Unit, Wellcome Trust Asia Program in Vietnam when the study was conducted and now is an assistant professor at NUS Saw Swee Hock School of Public Health in Singapore.

JE can be a difficult disease to track because only a small number of those infected are symptomatic. Those who are symptomatic are at a greater risk of death and many who survive are often left with considerable neurological and psychological systems.

"In terms of clinical care, many individuals who have a symptomatic infection with JE, but do not die, have severe longer-term disability,” Clapham said. “Understanding where infections of JE happen can therefore help with targeting of resources for supporting people who are suffering from the long-term impacts of a JE infection.”

Vaccination options exist to treat the disease, but it’s often difficult to estimate the impact of the disease and vaccination efforts with surveillance alone, Clapham said.

The computer model developed by investigators overcomes some of the limitations of sparse and variable surveillance data and provides a better sense of where to target vaccination efforts.

As part of the study, researchers reviewed the available case data on JE cases and grouped the data by age. Then using this data, researchers calculated what they called a Force of Infection (FOI), which showed the intensity of transmission within various regions.

Next, researchers used this FOI value to determine the disease burden in a particular area with and without data on vaccination programs, giving researchers a better sense of the impact vaccination had on a given area.

Clapham believes using the model to determine the regional disease burden in an area, could help identify the best areas to introduce a vaccine.

“For countries where we identified additional vaccination would be of use, further discussion will be needed with policymakers to determine the reasons for current vaccination uptake,” she said. “With information on these reasons, strategies can be developed to increase vaccination. We hope to engage with in-country policymakers as much as possible to further develop our work to be able to support these kinds of decisions."

Although researchers focused on the impact of JE in this latest study, Clapham said modeling can be effective in other disease states as well.

“The models used vary, depending on factors of disease, including how it is transmitted, and on the data available on case numbers, but modelling can be a useful approach to estimate burden for a number of infectious diseases,” she said.

Quan TM, Thao TTN, Duy NM, Nhat TM, Clapham H. Estimates of the global burden of Japanese encephalitis and the impact of vaccination from 2000-2015. 

A new computer model can help researchers predict the regional areas where vaccines are needed most.

Author | Jill Sederstrom

Articles

US Shingles Vaccination Rate Jumps, But There Is Still Room for Improvement

Study On Pharmacy Vaccination Rates Encourages Collaboration With Other Medical Providers

Pandemic Presents Unique Challenges for ADHD Management

Computer Model Helps Researcher Predict Regional Disease Burden