INTRODUCTION: Herpes zoster (HZ), a reactivation of the varicella-zoster virus, is characterized by a painful dermatomal rash and is associated with increased healthcare costs and decreased quality of life. Since 2018, the Advisory Committee on Immunization Practices (ACIP) has recommended recombinant zoster vaccine (RZV) for the prevention of HZ in adults aged ≥50 years. Despite these recommendations, RZV coverage for adults aged 50– 59 years remains suboptimal (7.3% in 2020). This study aimed to describe primary care providers (PCPs) knowledge, attitudes, and practices regarding HZ risk and vaccination for the prevention of HZ in adults aged 50–59 years.
METHODS: This was a cross-sectional web-based survey of 301 PCPs in the United States, including family physicians (N=100), internists (N=100), and nurse practitioners (N=101). Respondents were required to average ≥21 hours weekly in direct patient care, practice primary care (physicians), or adult primary or family care (nurse practitioners), report seeing patients aged 50-59 years, and provide electronic informed consent to participate. The survey included questions to assess PCPs knowledge, attitudes, and practices regarding HZ, adult vaccination, and HZ vaccination. Questions also assessed PCPs practice and demographic characteristics. Data were collected from 11/21/2022 to 11/30/2022. Descriptive statistics were used to summarize survey responses.
RESULTS: Overall, PCPs were knowledgeable about HZ: 82% correctly identified all risk factors for developing HZ, 86% identified postherpetic neuralgia (PHN) as the most common HZ complication, and 89% were aware that the risk of PHN after HZ increases with age. However, for HZ vaccination, only 44% and 29% of PCPs correctly identified FDA-approved indications and ACIP recommendations, respectively. This included a low awareness (39%) that vaccination is recommended for patients who previously received zoster vaccine live. Despite the fact that only 37% of PCPs felt that 50-59-year-olds were at very/extremely high risk for developing HZ (defined by selecting 4-5 on a 0-5 scale), 71% thought it was very/extremely important to vaccinate this age group against HZ. Overall, 81% of PCPs felt they were very/extremely likely to recommend a HZ vaccine to 50-59-year-olds; however, they only initiated conversations about HZ vaccination with 44% of patients in this age group during an average week. The most common circumstances identified by PCPs for not initiating such conversations were more urgent or acute issues to discuss during appointments (76%) and the patient being already vaccinated for HZ (69%). The most common barriers (moderate/major) to PCPs recommending HZ vaccination to 50-59-year olds included lack of time to assess risk factors during appointments (53%), the fact that patients may be due for other higher priority vaccines (45%), contraindications (45%), inadequate reimbursement for the vaccine (41%), and inability to confirm vaccination history (33%).
CONCLUSION: This survey identified gaps in PCPs’ knowledge and practices for HZ vaccination for adults aged 50-59 years. Given the important role PCPs have in prevention, as well as high HZ risk and suboptimal HZ vaccination coverage in adults aged 50-59 years, it is important to address these gaps. Support from other care team members may help ensure appropriate care for these patients.
