麻豆女优

(Steve Debenport/Getty Images)

Federal officials have recommended a new vaccine that is more effective than an earlier version at protecting older adults against the painful rash called shingles. But persuading many adults to get this and other recommended vaccines continues to be an uphill battle, physicians and vaccine experts say.

鈥淚鈥檓 healthy, I鈥檒l get that when I鈥檓 older,鈥� is what adult patients often tell Dr. Michael Munger when he brings up an annual flu shot or a tetanus-diphtheria booster or the new shingles vaccine. Sometimes they put him off by questioning a vaccine鈥檚 effectiveness.

鈥淭his is not the case with childhood vaccines,鈥� said in Overland Park, Kan., who is president of the American Academy of Family Physicians. 鈥淎s parents, we want to make sure our kids are protected. But as adults, we act as if we鈥檙e invincible.鈥�

The for people age 19 and older was published in February following a recommendation last October by the federal Centers for Disease Control and Prevention鈥檚 Advisory Committee on Immunization Practices and subsequent approval by the director of the CDC. The was to recommend the shingles vaccine that was approved by the Food and Drug Administration last fall, over an older version of the vaccine.

The new vaccine, Shingrix, should be given in two doses between two and six months apart to adults who are at least 50 years old. The older vaccine, Zostavax, can still be given to adults who are 60 or older, but Shingrix is preferred, according to the CDC. In clinical trials, Shingrix was 96.6 percent effective in adults ages 50 to 59, while Zostavax was 70 percent effective. The differences were Effectiveness in adults 70 and older was 91.3 percent for Shingrix, compared with 38 percent for Zostavax. Shingrix also provided longer-lasting protection than Zostavax, whose effectiveness waned after the first year.

The guidelines suggest that people who already had the Zostavax shot be revaccinated with Shingrix.

The of Shingrix costs about $280, while Zostavax runs $213.

鈥淲hat鈥檚 remarkable [about the new vaccine] is that the high level of immunity persists even in the very old,鈥� said a neurologist who is an expert on shingles. 鈥淚t鈥檚 pretty hard to get the immune system of older people excited about anything.鈥�

Shingles is caused by the same varicella-zoster virus that causes chickenpox. The virus can re-emerge decades after someone recovers from chickenpox, often causing a painful rash that may burn or itch for weeks before it subsides. will get shingles during their lifetime; there are roughly 1 million cases every year. People are more likely to develop shingles as they age, as well as like postherpetic neuralgia, which can cause severe, long-standing pain after the shingles rash has disappeared. In rare cases, shingles can lead to blindness, hearing loss or death.

Although shingles vaccination rates have inched upward in recent years, who were 60 or older received the Zostavax vaccine in 2016.

Other adult vaccine coverage rates 45 percent for the flu vaccine and 23 percent each for pneumococcal and tetanus-diphtheria-pertussis vaccines.

In contrast, by the time children are 3 years old, typically more than 80 percent of kids, and frequently more than 90 percent,

What gives? Cost can be a big deterrent for adult vaccines. The helps parents whose kids are eligible for Medicaid or are uninsured cover the cost of vaccines up to age 19.

Adults with private insurance who get vaccines recommended by the CDC also are sheltered from high costs because the shots must be covered by most commercial plans without charging consumers anything out-of-pocket, under a provision of the Affordable Care Act. Patients, however, should confirm their coverage before requesting the new shingles vaccine, because insurers typically add new vaccines gradually to their formularies after they have been added to the recommended list, and consumers may need to wait a little while for coverage.

But for people age 65 and older is much less comprehensive. Vaccines to prevent influenza and pneumonia are covered without a copayment under Medicare Part B, which covers outpatient care.

Other vaccines, including the shingles vaccine, are typically covered under Part D drug plans, which may leave some beneficiaries on the hook for all or part of the cost of the two-shot series.

That can pose a significant problem for patients. 鈥淣ot every Medicare beneficiary elects Part D, and even if you do, some have deductibles and copayments,鈥� said an infectious-diseases specialist at Vanderbilt University School of Medicine.

Even if adults want to get recommended vaccines, they sometimes lose track of which they have received and when. Pediatricians routinely report the vaccines they provide to state or city vaccination registries that electronically collect and consolidate the information. But the registries are not widely used for adults, who are more likely to get vaccines at various locations, such as a pharmacy or at work, for example.

鈥淚鈥檓 always asking patients, 鈥楧id you get all the doses in the series?鈥� 鈥榃here did you get them?鈥欌�� said Dr. Laura Riley, vice chair of obstetrics at Boston鈥檚 Massachusetts General Hospital who is a member of the Advisory Committee on Immunization Practices. 鈥淚t can be very challenging to track.鈥�