Survey of Physician Practices, Attitudes, and Knowledge Regarding Recombinant Zoster Vaccine

Herpes zoster vaccination among Medicare beneficiaries with and without prescription drug coverage

INTRODUCTION

The Inflation Reduction Act (IRA) eliminated cost sharing for Medicare Part D-covered vaccines but did not address the cost burden faced by Medicare beneficiaries who did not have prescription drug coverage. This study aimed to determine the characteristics of beneficiaries without prescription drug coverage and to assess the association between the receipt of a herpes zoster vaccine and prescription drug coverage status.

METHODS

We used the 2019-2023 National Health Interview Survey and included Medicare beneficiaries aged 65 years and older who enrolled in both Parts A and B or a Medicare Advantage plan. Descriptive statistics were used to examine beneficiaries' characteristics. Logistic regressions were used to examine the associations between the receipt of a herpes zoster vaccine and Medicare prescription drug coverage.

RESULTS

The study included 33,578 beneficiaries and 93.5 % of beneficiaries had prescription drug coverage. The prevalence of lacking prescription drug coverage was higher among beneficiaries who did not have a college degree, had family income below the poverty level, had no flu shot and well visit within the past year, and had no usual place for care. The probability of receiving a herpes zoster vaccine was higher among beneficiaries with prescription drug coverage than those without prescription coverage (45.2 % versus 25.3 %).

CONCLUSIONS

Herpes zoster vaccination disparities between beneficiaries with and without prescription drug coverage existed before the IRA. Because the IRA only addresses the cost barrier facing by beneficiaries with prescription drug coverage, vaccination disparities was greater after the IRA implementation.

Vaccination Coverage for Medically Indicated Vaccines in a Convenience Sample of Severely Immunocompromised Patients with COVID-19: An Observational Cohort Study

BACKGROUND

In recent decades, the number of immunocompromised patients (ICPs) has increased significantly. ICPs have an impaired immune system, making them susceptible to complicated infections. To protect them from infections, ICPs are eligible to receive several medically indicated vaccines. To obtain insight into the uptake of these medically indicated vaccines, we determined the coverage of these vaccines in ICPs.

METHODS

This observational cohort study was conducted at the University Medical Centre Utrecht, the Netherlands, from September 2021 to April 2022. All adult ICPs admitted for COVID-19 were asked to complete a questionnaire on their vaccination history (pneumococcal, herpes zoster, human papillomavirus vaccination, influenza, and COVID-19 vaccines) and history of vaccine-preventable infections. In addition, patients' vaccination history was reviewed in medical files.

RESULTS

A total of 115 patients completed the questionnaire and were included. Although all patients had an indication for pneumococcal vaccination, only 22 received it (19%). Coverage for herpes zoster was low (1%, 1/106 eligible patients). Coverage for human papillomavirus vaccination (HPV) was also low (40%, two out of five eligible patients). In contrast, 92% of patients received vaccination against SARS-CoV-2, and 77% of patients received seasonal influenza vaccination.

CONCLUSIONS

Although coverage for influenza and COVID-19 vaccination was high in ICPs, coverage for other medically indicated vaccines was low. Identifying which factors contributed to high COVID-19 and influenza vaccine uptake can help to improve vaccination rates for the other recommended vaccines. Clear guidelines for clinicians and the removal of organizational obstacles are needed to improve vaccination coverage.

Vaccination Motivators and Deterrents Among Undervaccinated Older Adults in North Dakota

Despite increased risk of morbidity and mortality among older adults due to preventable infectious diseases such as influenza, shingles, pneumonia, and COVID-19, many forego receiving some, if not all, of these vaccinations. This study examines vaccination motivators and deterrents for undervaccinated older adults in North Dakota (ND). Adults aged 65+ in ND were mailed a survey (n = 901) with questions gauging vaccination behaviors and perceptions, with 132 of these indicating not receiving certain vaccinations. Further questions assessed reasons they have not been vaccinated against the following diseases: influenza, shingles, pneumonia, and COVID-19 (e.g., "Concerned about side effects", "Vaccines are dangerous", "I'm healthy and I do not need it") and what would make it more likely to get a vaccine (e.g., "More information", "Doctor recommendation", "Easy access to vaccines"). Reasons for remaining unvaccinated varied by vaccine. For influenza and pneumococcal vaccines, respondents were more likely to indicate they are healthy and do not need the vaccine. For shingles and COVID-19, respondents were more likely to indicate concerns about side effects. Factors reported to motivate increasing the likelihood of getting a vaccine were receiving a doctor recommendation, receiving more information, and having a vaccine provided at no cost. These results contribute to our understanding of vaccination behaviors among older adults and underscore specific issues around which to frame interventions tailored to increase vaccine uptake for this population.

Knowledge, Attitudes, and Practices Regarding Herpes Zoster Vaccination Among Specialists

Recombinant zoster vaccine has been recommended by the US Advisory Committee on Immunization Practices (ACIP) for the prevention of herpes zoster (HZ) in immunocompetent adults aged at least 50 years since 2018. In January 2022, this was extended to immunodeficient/immunosuppressed adults aged at least 19 years. Key study objectives were to assess specialists' knowledge of the ACIP HZ vaccination recommendations, their attitudes toward HZ vaccination, and HZ vaccination practices/barriers. This cross-sectional, web-based survey (conducted in March 2022) included US dermatologists, gastroenterologists, infectious disease specialists, oncologists, and rheumatologists who treat patients with psoriasis, inflammatory bowel disease, human immunodeficiency syndrome, solid tumors/hematological malignancies, and rheumatoid arthritis, respectively. Although most of the 613 specialists correctly identified the ACIP HZ vaccination recommendations for adults aged at least 50 years (84%) and immunodeficient/immunosuppressed adults aged at least 19 years (67%), only 29% knew that recombinant zoster vaccine is recommended for individuals who have previously received zoster vaccine live, and only 18% knew all current ACIP recommendations. For patients with the diseases listed, 84% of specialists thought that HZ is a serious risk, 75% that HZ vaccination is extremely/very important, and 69% were extremely/very likely to recommend HZ vaccination. Only 36% administer vaccines themselves, mainly because patients receive vaccinations from others. Barriers to vaccination included more urgent/acute issues, insufficient time, and lack of patient motivation/willingness. Full knowledge of the ACIP HZ vaccination recommendations among the surveyed specialists was low. There may be a need to educate specialists to improve adherence to these recommendations. [Figure: see text].

Updated Public Health Impact and Cost Effectiveness of Recombinant Zoster Vaccine in Canadian Adults Aged 50 Years and Older

OBJECTIVES

The aim of this study was to update previously estimated public health impact and cost effectiveness of recombinant zoster vaccine (RZV) for the prevention of herpes zoster (HZ) in Canadians aged ≥50 years using longer-term RZV efficacy and waning data and real-world coverage and completion.

METHODS

A multicohort Markov model was used to conduct a cost-utility analysis comparing RZV with no HZ vaccination among Canadians aged ≥50 years. Real-world data were used for first-dose coverage (17.5%) and second-dose completion (65%). Vaccine efficacy and waning data were applied from up to 8-year follow-up from the ZOE-50 and ZOE-70 clinical trials. Incremental costs and benefits were calculated using a lifetime horizon from the healthcare payer (base case) and societal perspectives. A discount rate of 1.5% was applied to costs and quality-adjusted life-years (QALYs).

RESULTS

The model estimated that RZV would prevent 303,835 HZ cases, 83,256 post-herpetic neuralgia (PHN) cases, 39,653 other complications, and 99 HZ-related deaths compared with no HZ vaccination. Incremental cost-effectiveness ratios (ICERs) were estimated to be $27,486 and $22,097 per QALY (2022 Canadian dollars [CAN$]) from the healthcare payer and societal perspectives, respectively. The base-case ICER was most sensitive to a lower percentage of initial HZ cases with PHN. Almost all probabilistic sensitivity analysis simulations (98.1%) resulted in ICERs

CONCLUSIONS

RZV is expected to remain a cost-effective option for Canadian adults aged ≥50 years when using longer-term RZV efficacy and waning estimates, although the estimated public health impact was smaller than in the previous analysis (due to lower coverage/completion estimates).

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Grants

• GlaxoSmithKline Biologicals

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Affiliation(s)

Sydney George GSK, Mississauga, ON, Canada.
Justin Carrico RTI Health Solutions, Research Triangle Park, NC, USA
Katherine A Hicks RTI Health Solutions, Research Triangle Park, NC, USA
Dessi Loukov GSK, Mississauga, ON, Canada
Cheryl Ng GSK, Singapore, Singapore
Jessica Regan GSK, Mississauga, ON, Canada
Nikolaos Giannelos GSK, Wavre, Belgium

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Knowledge, Attitudes and Practices Survey of Recombinant Zoster Vaccine among Cardiologists and Cardiac Nurses in Italy

Background and Objectives: Cardiac patients are particularly at risk of herpes zoster (HZ), which is associated with a higher risk of major cardiovascular events. This research aimed to analyze the knowledge, attitudes and practices towards recombinant zoster vaccine (RZV) among cardiac healthcare professionals (HPs). Materials and Methods: A cross-sectional survey was conducted in a cardiological hospital in Italy. Multivariate regression models were built to identify factors associated with the outcomes of interest. Results: The response rate was 78.2% (154/197). Overall, age > 50 years and immunosuppression were recognized as risk factors for HZ by 38.3% and 75.3% of respondents, respectively. Regarding RZV, 29.1% of the HPs correctly responded about its schedule and 57.6% about the possibility of administration in immunocompromised individuals. This knowledge was significantly higher in HPs with a higher educational level (odds ratio (OR) = 4.42; 95%CI 1.70-11.47), in those who knew that HZ could cause postherpetic neuralgia (OR = 2.56; 95%CI 1.05-6.25) or major cardiovascular events (OR = 4.23; 95%CI 1.50-11.91), in those who had participated in professional updates on vaccinations (OR = 3.86; 95%CI 1.51-9.87) and in those who stated the need for further information about the RZV (OR = 6.43; 95%CI 1.42-29.98). Younger HPs (coefficient (β) = -0.02; 95%CI -0.04--0.01), those with a positive attitude toward RZV safety (β = 2.92; 95%CI 2.49-3.36) and those who had previously cared for patients with HZ (β = 0.45; 95%CI 0.03-0.88) reported a more positive attitude toward RZV effectiveness. The practice of recommending vaccination was more prevalent in younger HPs (OR = 0.94; 95%CI 0.89-0.99), in those who had a master's degree or higher education (OR = 7.21; 95%CI 1.44-36.08), in those with more positive attitudes toward RZV effectiveness (OR = 7.17; 95%CI 1.71-30.03) and in HPs who had already recommended the vaccine to patients in the past (OR = 4.03; 95%CI 1.08-14.96). Conclusions: Despite being a single-center study, our research brings attention to factors that currently impact cardiac HPs' approaches to RZV. The findings indicate potential measures to enhance HPs' awareness and practices, ultimately aiming to improve vaccination adherence and reduce the burden associated with HZ.

Willingness to receive Herpes Zoster vaccination among adults and older people: A cross sectional study in Italy

The objective of this study was to explore the Herpes Zoster (HZ) knowledge and the willingness to receive the HZ vaccination in adults and older people in Italy. The study was conducted on a sample of patients aged ≥65 years and over 50 years with chronic conditions who went to the clinics of general practitioners (GPs) in Campania region, Italy. Data was collected with a questionnaire administered through an interview. Multivariate logistic regression analysis was performed. 427 participants (83.2 %) had heard about HZ infection and correctly knew the main symptoms of the HZ disease, and 196 of them (45.9 %) were aware of the main complications of the infection, such as post-Herpetic Neuralgia (NPE) and Herpes Zoster ophthalmicus (HZO). Only 61 participants (11.8 %) had heard of the availability of a vaccination against HZ in Italy and 39 of them (63.9 %) knew that the vaccination is recommended in at-risk patients aged at least 50 years and for adults aged ≥65 years. 137 participants (26.6 %) had a positive attitude toward the willingness to receive the HZ vaccination. Participants aged 50-64 years, those who have more than one chronic disease, those who have received at least one recommended vaccination, those who had a positive attitude on the usefulness of HZ vaccination, and those who feel the need to receive additional information about HZ vaccination were more likely to have a positive attitude toward the willingness to receive the HZ vaccination. It is needed to implement effective strategies to improve HZ vaccination coverage in order to protect especially frail patients from the most serious complications of the disease.

The Knowledge, Attitude and Practice Among Makkah Physicians Towards Herpes Zoster Vaccination, Saudi Arabia, 2023

Background Herpes zoster (HZ) is a viral disease, which is more common among the elderly and immunodeficient individuals, among which approximately 22% of cases might progress to post-herpetic neuralgia (PHN). Hence, this study aimed to assess the knowledge, attitude and practice (KAP) towards HZ and its vaccination among primary health care physicians in Makkah, Saudi Arabia, 2023. Methodology This analytical cross-sectional study used an online pre-validated questionnaire and was conducted from July to August 2023. The target population included physicians working in primary healthcare (PHC) daily clinics in Makkah. Results A total of 153 participants were included in the current study. Of which 90 (58.8%) were females and 120 (78.4%) participants had chicken pox history. Around 123 (80.4%) had previously heard about shingles. The most reported source of information was physicians (63%) followed by the Internet (12.2%). Risk factors for shingles were found to be immunodeficiency (95.1%) and age (78%). Most (88.2%) participants had previously heard about the shingles vaccine and 99 (64.7%) reported that the shingles vaccine is needed even if the patient had chicken pox in the past. Most participants (82.4%) knew that the vaccine should be given to adults aged more than 50 years. About 69 (45.1%) thought that they were extremely likely to get the shingles vaccine if the doctor recommended it. Barriers to shingles vaccination among study participants included participant's perception that they were not at risk of getting shingles (33%) and concerns about vaccines' side effects (27.5%). The average knowledge score about shingles was found to be 9.51 ± 3.14 and the average knowledge score about shingles vaccine was found to be 5.43 ± 1.46. Gender was significantly associated with knowledge score about the vaccine (p-value= 0.028) where females had higher knowledge scores about shingles vaccine as compared to males. Qualification level and current Saudi Commission for Health Specialties (SCFHS) classification were found to be significantly associated with knowledge scores about shingles (p-value = 0.002 and 0.003, respectively). Conclusion A good level of KAP about shingles and its vaccine was found among the study participants. However, few knowledge gaps in methods of protection were assessed. Female gender, married participants and higher SCFHS qualification level were positively associated with higher levels of knowledge and awareness as compared to other groups.

Dutch Healthcare Professionals' Opinion on the Allocation of Responsibilities concerning Prescribing and Administering Medically Indicated Vaccines to Immunocompromised Patients

BACKGROUND

Specific vaccines are indicated for immunocompromised patients (ICPs) due to their vulnerability to infections. Recommendation of these vaccines by healthcare professionals (HCPs) is a crucial facilitator for vaccine uptake. Unfortunately, the responsibilities to recommend and administer these vaccines are not clearly allocated among HCPs involved in the care of adult ICPs. We aimed to evaluate HCPs' opinions on directorship and their role in facilitating the uptake of medically indicated vaccines as a basis to improve vaccination practices.

METHODS

A cross-sectional survey was performed among in-hospital medical specialists (MSs), general practitioners (GPs), and public health specialists (PHSs) in the Netherlands to assess their opinion on directorship and the implementation of vaccination care. Additionally, perceived barriers, facilitators, and possible solutions to improve vaccine uptake were investigated.

RESULTS

In total, 306 HCPs completed the survey. HCPs almost unanimously (98%) reported that according to them, the primary treating physician is responsible for recommending medically indicated vaccines. Administering these vaccines was seen as a more shared responsibility. The most important barriers experienced by HCPs in recommending and administering were reimbursement problems, a lack of a national vaccination registration system, insufficient collaboration among HCPs, and logistical problems. MSs, GPs and PHSs all mentioned the same three solutions as important strategies to improve vaccination practices, i.e., reimbursement of vaccines, reliable and easily accessible registration of received vaccines, and arrangements for collaboration among the different HCPs that are involved in care.

CONCLUSION

The improvement in vaccination practices in ICPs should focus on better collaboration among MSs, GPs, and PHSs, who should know each other's expertise; clear agreement on responsibility; reimbursement for vaccines; and the availability of clear registration of vaccination history.