Many PCPs unaware of current ACIP shingles vaccine guidance, study finds

While most (82%) primary care physicians (PCPs) in the United States understand the risk factors for shingles, far fewer (29%) are fully aware of current shingles vaccine recommendations, according to a recent study published in Human Vaccines and Immunotherapeutics. The study was sponsored by GSK, the manufacturer of the recombinant zoster vaccine (RZV).

Shingles, or herpes zoster, is a painful, blistering rash that typically appears on the torso and is caused by reactivation of the varicella-zoster virus—the same virus responsible for chickenpox. Because almost all people born before 1980 have been infected with chickenpox, the majority of adults in the United States carry the virus. As a result, approximately 1 million people nationwide develop shingles each year.

Shingles can spread through direct contact with fluid from open blisters or by inhaling virus particles released from the blisters. However, the virus is not contagious before blisters appear or after lesions have scabbed over. Risk increases with age and immunosuppression, and complications can include postherpetic neuralgia, vision loss and hospitalization.

The U.S. Advisory Committee on Immunization Practices (ACIP) has updated its shingles vaccine guidance multiple times over the past decade. In 2008, ACIP first recommended the live zoster vaccine (ZVL) for adults aged 60 and older. In 2018, the committee updated its guidance to recommend the recombinant zoster vaccine (RZV) over ZVL for immunocompromised adults up to age 50. ACIP updated the recommendation again in 2022 to include immunocompromised adults aged 19 years and older.

For the current study, researchers surveyed 301 PCPs about shingles, vaccines, and vaccination practices. The research team included Eric Davenport, MStat, MEcon, a senior statistician at RTI Health Solutions.

Results showed that PCPs generally recognized the importance of shingles vaccination and understood that shingles risk increases with age. Overall, 82% of respondents correctly identified key risk factors for shingles. However, fewer than half (44%) were aware of all approved vaccine indications and just 29% reported full awareness of current ACIP recommendations.

PCPs also identified several barriers to recommending or administering the shingles vaccine. These included inadequate reimbursement for vaccination, limited time during patient visits to discuss immunization and patient reluctance or lack of interest in receiving the vaccine.

“Proactive efforts should, therefore, be made to provide updated information to PCPs about the current ACIP recommendations,” Davenport said in the study. “Increasing awareness of the minimal RZV contraindications and nearly eliminated out-of-pocket costs for adult vaccines could help address perceived barriers to recommending or administering herpes zoster vaccination.”

Davenport added that there may also be opportunities to improve implementation of ACIP recommendations by streamlining adult vaccination workflows and increasing patient education. Educating patients about their lifetime risk of shingles, the burden of disease, and potential complications could help improve vaccination uptake and reduce preventable illness.