Herpes Zoster Vaccine Uptake Among United States Adults With Rheumatic Disease: A Mixed-Methods Analysis

Adults with rheumatic diseases are at increased risk for herpes zoster (HZ). Recommendations for the recombinant zoster vaccine (RZV) were expanded in 2021 to include those aged ≥19 years at increased risk for HZ due to immunodeficiency or immunosuppression because of disease or therapy, but the impact of these expanded recommendations is unclear. This study assessed the impact of the updated recommendations on RZV uptake among adults with rheumatic disease in the US.

A retrospective cohort analysis used open-source claims data to estimate RZV uptake, series completion, and dosing schedule compliance among unvaccinated adults with rheumatic disease from October 2021 to June 2023. Interviews with rheumatologists were conducted and thematically analyzed to characterize RZV vaccination practices related to managing patients with rheumatic disease.

RZV uptake among adults with rheumatic disease and without prior RZV over the 20-month period following the updated recommendations was gradual (7.0%-10.4% across conditions) and low, and was particularly less likely among adults <50 years of age. The odds of RZV uptake were higher among those of older age, those with a household income greater than or equal to $50,000, and those of a non-White race or ethnicity. Financial concerns, lack of formal processes for tracking vaccination records and delivering reminders, and insufficient education and awareness were key barriers to RZV vaccination according to rheumatologists.

RZV uptake among adults with rheumatic disease has gradually increased, and opportunities to improve HZ prevention exist, some of which may be addressed through targeted educational efforts.