Andrew Laming (Bowman, Liberal Party) Share this | Hansard source

Deputy Speaker, thank you for the opportunity to talk about this very, very important topic. Particularly for older Australians over the age of 50, the herpes zoster virus is a significant cause of morbidity. All of us will have had personal experience with chickenpox in children. The herpes zoster virus is simply a manifestation of that disease later in life. It has significant chronic impacts. I am very familiar with those impacts having been an eye surgeon treating herpes zoster ophthalmicus, which is an occurrence from this infection that occurs in about 20 per cent of cases, mostly in older Australians.

Vaccines that are effective in the herpes family have been a long time coming. The herpes zoster virus is probably the most significant cause of morbidity in older Australians in that family of over five different herpes varieties. The herpes zoster virus is responsible for significant pain and suffering for older Australians. Understanding the economics of the benefits of a vaccine requires that we look at the age of the person, because not only is age going to affect the incidence and the severity of the condition but also the vaccine itself is less effective as one becomes older. The economics of life expectancy at every age point in time start to also mean that you have different cost benefits from the vaccination.

Evidence also is not complete for use of this vaccine in younger patients. It is registered for use by those over the age of 50. There was a very important budget announcement that made it available to 70-year-olds, which I commend, and in addition to that there is a catch-up program for those who were recently 70 years of age. If you are between 70 and 80 now you can be reasonably confident that over the catch-up period you will have access to this vaccine. Of course, there is nothing to stop you going out and getting that on the free market, but it is now added to the national immunisation program. It is an important benefit. We are always going to be looking as well at those under the age of 70. There is quite a lot of evidence around those aged 60 to 70. The vaccine's efficacy becomes weaker in those aged 50 to 60.

What we are talking about is familiar to everyone. Most of us can recall having chickenpox in our youth. We cannot always be sure it was, in fact, chickenpox, but that really does not matter. In our lifetime we will see about a quarter of Australians having an episode of the herpes zoster virus, making immunisation something worth considering. Those painful vesicular rashes are very much restricted to what we call the dermatomes, the areas of the body that are covered by a nerve—in this case, a cranial nerve. They demarcate the area where you can get those rashes. Rashes very much conform to those dermatomes.

The small percentage chance that you will have more than just the pain of the immediate episode is the great concern. It is not the immediate infection that is necessarily the problem; it is a whole series of what we call sequelae that can follow with time. When there is pain in the affected area lasting more than 120 days after the initial infection, we consider that to be postherpetic neuralgia. That kind of a pain, which can exist for years, is worse in those who are older. It can be associated also with a range of other outcomes. There is local scarring and pigmentation of the skin where the rash has occurred. There is the ocular involvement that can lead to severe ocular problems, which I will talk about in a second. There is even the possibility of meningitis and other systemic infections where large parts of the body are affected. These neurological problems are extremely rare and they are most commonly seen either in people who are living asymptomatically with HIV, for instance, or in someone who has had some other type of treatment that might affect their immune status. In those cases, on a case-by-case basis, you would want to consider the benefits of vaccination.

Right now we have the program that is approved for those who are 70 and above. But I commend the member for Ryan for raising this bigger picture, which is that this is a relatively affordable vaccine. Through more and more detailed cost-effectiveness analysis, I hope it will be considered in the future for younger populations. Anyone who has seen a patient living with postherpetic neuralgia would know that its treatment is limited to only a very few versions of analgesia to reduce pain. This pain can go on for years. It is something that a vaccination can make a complete difference to.

Remember that it is not a complete cover. We are talking about reducing the incidence of the disease by around 50 per cent. We would be trying to reduce the severity and duration of that postherpetic neuralgia with a vaccine. We see reductions of about two-thirds in those over the age of 70 and slightly less than that for those under. It is well worth considering. We will see further cost-effectiveness analysis leading to further approvals, I am sure.

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