Herpes zoster in Belgium: a new solution to an old problem.

Herpes zoster (HZ) is caused by reactivation of the varicella-zoster virus. The life-time risk of developing HZ is ~ 30%. Management of HZ can be challenging due to limited efficacy of oral antivirals on pain control, and neuropathic pain that may require aggressive management. Post-herpetic neuralgia (PHN) can cause substantial pain and occurs in up to one-quarter of patients with HZ. Up to 48,000 HZ cases are estimated to occur annually in Belgium, estimated to cost almost 7 million euros in treatment. The recombinant zoster vaccine (RZV, Shingrix, GSK) was approved in Europe in 2017. In 2022, the Belgian Superior Health Council recommended vaccination with RZV for immunocompetent adults aged ≥ 60 years, and immunocompromised patients aged ≥ 16 years, including those receiving immunosuppressive therapy, in particular Janus kinase inhibitors. RZV showed high age-independent efficacy in preventing HZ infection and in clinical trials that has since been confirmed in real-world effectiveness studies. In clinical trials, protection was sustained for at least 10 years after vaccination. As of 1 November 2023, RZV is reimbursed for three immunocompromised patient groups aged ≥ 18 years: malignancy treated in the past 5 years, HIV infection, and organ or haematological stem cell transplantation or are a transplant candidate. HZ is vaccine-preventable and RZV provides a highly effective tool for HZ prevention. While reimbursement for some at-risk groups is welcomed, reimbursement currently falls well short of Superior Health Council recommendations. Adult immunisation strategies should be promoted to achieve high vaccination coverage against HZ, contributing to healthy aging in Belgium.

What is the context?Shingles (herpes zoster) is a common disease in adults that occurs more frequently as people age. The shingles' rash is frequently intensely painful. Antiviral treatments and pain killers can help, but they are usually not fully effective in reducing pain or shortening the disease.Shingles can be prevented in more than 90% of adults by vaccination.What is new?In 2022, the Belgian Superior Health Council recommended vaccination with recombinant zoster vaccine for immunocompetent adults aged ≥60 years, immunocompromised patients, including those receiving immunosuppressive therapy aged ≥16 years.What is the impact?Implementation of the new recommendations can be expected to lead to fewer cases of shingles and its most common complication ­ post-herpetic neuralgia. In turn, fewer patients will need prescriptions for antivirals, sedatives, and strong pain killers or other drugs with significant side effects.

Assessing Barriers Encountered by Women in Cervical Cancer Screening and Follow-Up Care in Urban Bolivia, Cochabamba.

BACKGROUND: Timely detection of cervical cells infected with high-risk human papillomavirus (HPV) improves cervical cancer prevention. In Bolivia, actual screening coverage only reaches 33.3% of the target population aged between 25 and 64 years despite free cytology screening. Furthermore, 50% to 80% screened women are lost during follow-up. This study aimed at identifying factors explaining this lack of follow-up care. METHOD: During the first phase, face-to-face semi-structured interviews were conducted with HPV-positive women. Secondly, we explored the reasons for the non-adherence to the follow-up care: knowledge, perceptions and beliefs about HPV, as well as barriers to healthcare access, using a structured survey on Cochabamba women and healthcare professionals. RESULTS: Barriers to effective follow-up of the targeted populations were associated with health system shortcomings, including poor service delivery at the front- and second-line, health providers shortage, inadequate training, waiting time, high direct and indirect costs of care seeking and care, complex procedures to obtain HPV screening results and poor patient-provider communication. The follow-up was perceived as extremely stressful by the participants. CONCLUSION: Improved communication on HPV and HPV-related cancers in terms of representation in the general population and among the health professional's population is vital to improve access for HPV infection follow-up care.

Palliative care interventions in intensive care unit patients.

PURPOSE: The integration of palliative care into intensive care units (ICUs) is advocated to mitigate physical and psychological burdens for patients and their families, and to improve end-of-life care. The most efficacious palliative care interventions, the optimal model of their delivery and the most appropriate outcome measures in ICU are not clear. METHODS: We conducted a systematic review of randomised clinical trials and observational studies to evaluate the number and types of palliative care interventions implemented within the ICU setting, to assess their impact on ICU practice and to evaluate differences in palliative care approaches across different countries. RESULTS: Fifty-eight full articles were identified, including 9 randomised trials and 49 cohort studies; all but 4 were conducted within North America. Interventions were categorised into five themes: communication (14, 24.6%), ethics consultations (5, 8.8%), educational (18, 31.6%), involvement of a palliative care team (28, 49.1%) and advance care planning or goals-of-care discussions (7, 12.3%). Thirty studies (51.7%) proposed an integrative model, whilst 28 (48.3%) reported a consultative one. The most frequently reported outcomes were ICU or hospital length of stay (33/55, 60%), limitation of life-sustaining treatment decisions (22/55, 40%) and mortality (15/55, 27.2%). Quantitative assessment of pooled data was not performed due to heterogeneity in interventions and outcomes between studies. CONCLUSION: Beneficial effects on the most common outcomes were associated with strategies to enhance palliative care involvement, either with an integrative or a consultative approach. Few studies reported functional outcomes for ICU patients. Almost all studies were from North America, limiting the generalisability to other healthcare systems.

Palliative care interventions in intensive care unit patients - a systematic review protocol.

BACKGROUND: Even though data suggest that palliative care (PC) improves patient quality of life, caregiver burden, cost, and intensive care unit (ICU) length of stay, integration of PC in the ICU is far from being universally accepted. Poor understanding of what PC provides is one of the barriers to the widespread implementation of their services in ICU. Evidence suggests that the availability of specialist PC is lacking in most European countries and provided differently depending on geographical location. The aim of this systematic review is to compare the numbers and types of PC interventions and gauge their impact on stakeholder outcomes and ICU resource utilisation. METHODS: We will undertake a systematic review of the published peer-reviewed journal articles; our search will be carried out MEDLINE, Embase, Cochrane, CINAHL, and PsycINFO. The search strategy will include variations in the term 'palliative care' and 'intensive care'. All studies with patient populations undergoing palliative care interventions will be selected. Only full-text articles will be considered, and conference abstracts excluded. There will be no date restrictions on the year of publications or on language. The primary aim of the present study is to compare the numbers and types of PC interventions in ICU and their impact on stakeholder (patient, family, clinician, other) outcomes. Reporting of findings will follow the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. DISCUSSION: This review will provide insight into the implementation of palliative care in ICU, elucidate differences between countries and health systems, reveal most effective models, and contribute to identifying research priorities to improve outcomes. SYSTEMATIC REVIEW REGISTRATION: International Prospective Register of Systematic reviews PROSPERO ( CRD42018094315 ).