PURPOSE: Herpes zoster (HZ) is caused by reactivation of the varicella zoster virus and involves a painful dermatomal rash that may be followed by complications, such as postherpetic neuralgia. The Advisory Committee on Immunization Practices (ACIP) recommended recombinant zoster vaccine (RZV) for prevention of HZ in immunocompetent adults aged ≥50 years in 2018. In January 2022, the recommendation was extended to adults aged ≥19 years who are or will be immunocompromised (IC) due to disease or therapy. With this recent recommendation, this study sought to understand knowledge, attitudes, and practices of specialists who care for IC populations with regards to RZV.
METHODS: This was a cross-sectional, web-based survey of 613 physicians in the United States specializing in dermatology (N=150), gastroenterology (N=126), oncology (N=125), rheumatology (N=111), and infectious disease (N=101) who reported seeing adult patients (≥18 years) with psoriasis, inflammatory bowel disease, cancer, rheumatoid arthritis, or living with human immunodeficiency virus, respectively. Survey development included a feasibility assessment to inform eligibility criteria and question response ranges, as well as cognitive interviews with one of each type of specialist to ensure items, response options, and recall periods are understandable and easily answered. Respondents were required to average ≥21 hours weekly in direct patient care and provided electronic informed consent to participate. Specialists were excluded if they could not receive compensation for participation in the study based on their state or if they were one of the 5 specialists that participated in cognitive interviews. The survey included questions to assess specialists' knowledge, attitudes, and practices regarding vaccination in general, HZ, risk factors for HZ, and vaccination to prevent HZ. Questions also assessed specialists' practice settings and characteristics as well as demographic characteristics. Data were collected from March 4, 2022 to March 28, 2022. Descriptive statistics were used to summarize survey responses. The study was approved for exemption by an RTI institutional review board.
RESULTS: Among the 613 specialists, the most common work environments were private group practice (43%) and academic center (25%), with 49% and 46% of specialists reporting their practice to be in an urban or suburban setting, respectively. Most specialists reported recommending vaccines to adult patients (94%) while fewer reported prescribing (55%) or administering vaccines (36%) to adult patients. Overall, 43% of specialists correctly identified all FDA-approved RZV indications, including the indication for IC patients and for adults aged ≥50 years, but were less knowledgeable about the ACIP recommendations (18% provided all correct responses). Few (29%) specialists were aware that RZV is recommended for patients who previously received zoster vaccine live. Specialists reported having a conversation in the past year about HZ vaccination with a mean (standard deviation) of 42% (33%) of their adult patients with the disease of interest. Oncologists and dermatologists reported lower percentages for this question (37% [31%]) and 24% [26%], respectively). Specialists most frequently cited more urgent or acute issues to be discussed during the appointment (65%) as the reason for not initiating conversations with their patients regarding HZ vaccination, though specialists also cited patients having already been vaccinated against HZ as another common reason (61%).
CONCLUSION: Most specialists reported recommending vaccines, but this survey identified gaps in knowledge and practices regarding HZ vaccination. It is important to address these gaps given the risk of HZ in the IC populations that these specialists often care for and considering the recent ACIP recommendation supporting RZV vaccination for IC populations. Increased awareness of the ACIP recommendations and support from other healthcare professionals, including pharmacists, may help ensure appropriate care for these patients.
