Incidence of Herpes Zoster Infections in the Veterans Health Administration Long-Term Care Setting

To estimate the incidence of herpes zoster (HZ) and real-world vaccination rates among veterans admitted to Veterans Affairs (VA) Community Living Centers (CLCs) both before and during admission.

Observational cohort study.

A total of 16,799 veterans aged ≥50 years newly admitted for ≥90 days to VA CLCs between 2017 and 2024, with ≥1 year of baseline data.

Eligible veterans were identified using VA administrative and electronic health record data from the VA Corporate Data Warehouse. Demographics, comorbidities, and vaccination status were measured using diagnosis codes and pharmacy records. Incidence of HZ was measured from 90 days after admission until censoring for death, or December 31, 2024, stratified by vaccination status and history of prior HZ infection.

We identified 16,799 eligible veterans admitted to a CLC for at least 90 days. The average age was 74.9 years; 96.4% male and 63.7% White. The most common comorbidities included dementia (44.2%), hypertension (37.3%), hyperlipidemia (30.1%), anemia (23.8%), and diabetes (22.8%). Prior to admission, 35.3% had received the live zoster vaccine and 23.1% the recombinant zoster vaccine. Within 90 days postadmission, 482 (2.9%) had received at least one HZ vaccination dose. The cumulative incidence of HZ was 0.8% over 180 days, 1.4% over 365 days, and 2.1% over 720 days. Incidence of HZ was lowest in recombinant zoster vaccine-vaccinated individuals (1.2%) and highest in those with a prior history of HZ (4.1%).

This study provides the first large-scale characterization of HZ burden and vaccine uptake in VA nursing home residents. Coded HZ is fairly uncommon, and vaccination rates remain suboptimal. Institutional policies could prioritize systematic vaccination protocols at admission, and further research should evaluate the real-world effectiveness of vaccination in the nursing home population.