OMAHA — Efforts to promote use of a vaccine against herpes zoster, commonly called shingles, have been fraught with difficulty.
A recent letter-to-the-editor in the Wisconsin Medical Journal points out, “Zoster vaccine uptake has been disappointing (34.5% of the target population) and marred by racial and ethnic disparities. However, studies of uptake generally have limitations.”1
In addition, most reports have been survey-based and subject to self-report bias, as well as mainly based a discontinued live vaccine not the currently available recombinant vaccine,” according to the authors from the VA Nebraska-Western Iowa Health Care.
Another limitation is that many of the surveys concern a period three years ago when the recombinant vaccine was in shortage, they add.
“These limitations raise a question: Do these racial and ethnic disparities persist?” according to the letter. “Insight into that question may be gleaned from a quality improvement project that we initiated to improve zoster vaccine uptake.”
The advantages, according to the authors, is that their baseline findings overcome those limitations and that their findings are current, record-based, and reflect the recombinant vaccine. “Our findings are from a Veterans Health Administration clinic (where insurance and access are not barriers) and may shed light on the question of persistence of disparities, even when those barriers are absent,” they point out.
For the project, the study team queried the records of the Omaha primary care clinic of the Nebraska-Western Iowa Health Care System for receipt of recombinant zoster vaccine since Oct. 1, 2017. Included were patients at least 50 years old on Oct. 1, 2017, which was close to the recombinant vaccine approval date, and who were seen in the clinic Oct. 1, 2020-July 5, 2021. The population of 10,323 veterans was predominantly male (93.8%); 81.2% were non-Hispanic white, 10.7% were non-Hispanic Black, and 1.5% were Hispanic white.
Results indicate that the prevalence of complete vaccination (i.e., two doses) was 39.8% (females 34.7%, males 40.1%). Complete vaccination was 43.3% in non-Hispanic white patients, 33.8% in Hispanic white patients, and 24.9% in non-Hispanic Black patients. Receipt of at least one COVID-19 vaccine dose was 80.1%, 78.2% and 82.2%, respectively.
The authors note that a 39.8% prevalence of complete vaccination was higher than generally reported for zoster vaccine uptake. “Conceivably, this could reflect our study population: individuals seen in a clinic with vaccine reminders, standing vaccine orders, onsite vaccine, and no charge for vaccine. Racial and ethnic disparities are consistent with most, but not all, of the literature,” they add.
The researchers suggest, “The contrast between zoster vaccine disparities and their absence with COVID-19 vaccine (for which awareness was extraordinarily high) supports the hypothesis that zoster vaccine disparities arise from disparities in awareness.”
The study concludes that its baseline data “confirm the appropriateness of our choice of zoster vaccine uptake as a quality improvement project, showing an opportunity for improving uptake and an opportunity to address factors other than insurance and access that account for racial and ethnic disparities.”
- Bittner MJ, Truong GTD, Creech ZA. Racial and Ethnic Differences in Zoster Vaccine Uptake: A Cross-Sectional Study in a Veterans Health Administration Primary Care Clinic. WMJ. 2021 Oct;120(3):168-170. PMID: 34710295.
