Herpes zoster vaccination among older adults in urban China: A mixed-methods study in Shenzhen

Herpes zoster (HZ) poses a growing burden in aging populations, yet uptake of herpes zoster vaccines (HZVs) remains limited in China. This mixed-methods study examined HZV willingness and barriers among older adults in Shenzhen. We conducted a cross-sectional survey among older adults (N = 1,974), and semi-structured interviews with older adults and healthcare providers (HCPs) (N = 30). Quantitative analyses used a multinomial outcome (unwilling, hesitant, willing), while qualitative data were thematically analyzed and integrated with survey results using a joint display. Findings revealed that only 8.4% of respondents had received HZV, while 33.7% of unvaccinated participants (N = 1,809) expressed future HZV willingness. In multinomial regression, willingness (vs unwillingness) was associated with awareness of local HZV policy (aOR = 1.82, 95% CI: 1.38-2.40), awareness of HZV (aOR = 1.77, 95% CI: 1.34-2.35), previous SIV vaccination (aOR = 1.72, 95% CI: 1.32-2.22), awareness of life-course immunization (aOR = 1.69, 95% CI: 1.22-2.33), and female gender (aOR = 1.34, 95% CI: 1.06-1.70). Hesitancy (vs unwillingness) was associated with prior influenza vaccination (aOR = 1.76, 95% CI: 1.35-2.29) and prior COVID-19 infection (aOR = 1.46, 95% CI: 1.02-2.08), while age over 70 was associated with lower odds of hesitancy (aOR = 0.72, 95% CI: 0.53-0.98). Cost, unfamiliarity with HZV and low perceived risk were commonly reported barriers. Interviews described anticipated pain and trusted recommendations from HCPs and family as salient cues, alongside barriers related to affordability, limited awareness, concerns about side effects, reliance on traditional remedies, and constrained institutional support. Overall, HZV uptake among older adults in urban China remains suboptimal. Strategies to improve awareness, reduce financial barriers, and engage HCPs are critical.