BACKGROUND AND OBJECTIVESHerpes zoster (HZ), known as shingles disease, has several complications that greatly affect elderly and immunocompromised people. Despite evidence for HZ vaccine efficiency and cost-effectiveness, the uptake of the HZ vaccine is lower than that of other common adult vaccines. Strong recommendations by healthcare workers (HCWs) for the HZ vaccine could increase vaccine uptake.AIMThis study aimed to investigate HCWs' knowledge, attitude, and practice of the recombinant zoster vaccine (RZV) in Saudi Arabia and identify gaps and barriers in vaccine recommendation.MATERIALS AND METHODSA cross-sectional, questionnaire-based study was conducted in different hospitals in Riyadh, Saudi Arabia, between December 2023 and March 2024. An electronic self-administered validated questionnaire that assesses the knowledge, attitude, and practice of HCWs regarding the HZ vaccine was sent to all hospital staff. The collected data were organized, entered on an Excel sheet, and statistically analyzed using SPSS software. Pearson's chi-square test and Monte Carlo exact tests were used for data analysis.RESULTSA total of 309 HCWs responded to the survey. Family physicians, infectious diseases doctors, and dermatologists are essential to recommend vaccines in Saudi Arabia. In particular, 264 (86.4%) HCWs correctly identified the doses of RZV. However, 148 (47.9%) incorrectly believed that side effects from the first dose were a valid reason not to receive the second dose. Most HCWs (n = 235, 76.1) agreed that they need more direction on which immunocompromised patients are eligible for the RZV vaccine. Most physicians recommend the vaccine for patient groups mentioned in the Advisory Committee on Immunization Practices (ACIP) recommendations. However, 85 (27.5%) recommended the vaccine for healthy adults aged 18-49 years. Ninety-nine (32%) patients declined the vaccine as they did not think they were at risk for developing shingles and 73 (23.6%) declined due to fears of immediate side effects. Among the strategies recommended to increase vaccine uptake are distributing zoster vaccine pamphlets to patients and having a hotline or a website available to discuss zoster vaccination, which were recommended by 255 (82.5%) and 235 (76.1%) HCWs, respectively.CONCLUSIONSPhysicians in Saudi Arabia are generally knowledgeable about the HZ vaccine but need more guidance about ACIP recommendations. The patient reactions to the first dose, the limited vaccine availability, and the perception that RZV has not been adequately studied in immunocompromised patients are among the barriers to vaccine recommendation. Pamphlets regarding the HZ vaccine and a hotline or a website available for discussion about the vaccine are recommended strategies to increase vaccine uptake.

2025-01-01·American Journal of Ophthalmology

Risk Factors for the Development of Ocular Complications in Herpes Zoster Ophthalmicus and Zoster Vaccine Utilization in a Large, Urban Health System

Article

作者: Song, Amy ; Mehta, Supriya D ; Mehta, Supriya D. ; Lobo-Chan, Ann-Marie ; Kadakia, Arya

PURPOSETo characterize the epidemiology of herpes zoster (HZ) and herpes zoster ophthalmicus (HZO) in an urban hospital system and determine risk factors associated with developing ocular complications in HZO. To report the frequency of shingles vaccination and HZ reactivation following shingles vaccination in this population.METHODSA retrospective cohort study was conducted on patients seen at the University of Illinois Hospital system from January 1, 2010 to December 1, 2021 with HZ and HZO identified by diagnosis code. Charts of HZO patients seen within 1 year of diagnosis were abstracted. Multivariable logistic regression analysis identified factors associated with the development of ocular complications in HZO.RESULTSDuring the study period, 3283 patients had HZ; mean age of onset was 52.3 years, 61.6% were female, and 37% were Black. HZO with ocular involvement was seen in 110 (3.4%) patients. Ocular complications developed in 40 (36.4%) patients; the most common complication was corneal scarring (70%). Age (odds ratio [OR] 1.04, 95%CI 1.0-1.1), female gender (OR 2.86, 95%CI 1.0-8.1), steroids at initial visit (4.46, 95%CI 1.4-14.6), and stromal keratitis (OR 3.45, 95% CI 1.2, 9.8) were associated with developing ocular complications. Of eligible populations, 5333 (1.5%) received shingles vaccination; 43 patients developed reactivation of HZ following vaccination.CONCLUSIONSIn HZO, age, female gender, steroids at initial visit, and stromal keratitis are strongly associated with developing ocular complications. Shingles vaccination rates were low in this study population. Understanding potential for complications in HZ/HZO and vaccination uptake can help identify at risk populations to prevent disease. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

2024-10-01·Journal of Microbiology, Immunology and Infection

Recommendations and guidance for herpes zoster vaccination for adults in Taiwan

Review

作者: Liu, Chia-Wei ; Chen, Yee-Chun ; Tsai, Wen-Chia ; Hung, Miao-Chiu ; Cheng, Ming-Fang ; Wang, Fu-Der ; Chiu, Nan-Chang ; Wu, Ping-Feng ; Huang, Chien-Hsien ; Lin, Po-Chang ; Wang, Hsiao-Wei ; Wong, Swee Siang ; Lee, Susan Shin-Jung ; Wang, Ning-Chi ; Lin, Kuan-Yin ; Lin, Hsiao-Chuan ; Hsieh, Szu-Min ; Su, Lian-Yi ; Tsai, Ming-Han ; Chang, Chia-Ning ; Wang, Ching-Hsun ; Lin, I-Fan ; Yang, Shun-Cheng

Herpes zoster (HZ) is a painful, vesicular, cutaneous eruption from reactivation of varicella zoster virus (VZV), which can lead to potentially debilitating complications. The lifetime risk of HZ is estimated to be 20%-30% in the general population, with an increased risk in the elderly and immunocompromised populations. The most effective strategy to prevent HZ and its complications is by vaccination. Two types of HZ vaccines, zoster vaccine live and recombinant zoster vaccine, have been approved for use. This guidance offers recommendations and suggestions for HZ vaccination in adults, aiming to reduce the disease burden of HZ and its complications. It is intended as a guide to first-line healthcare providers, but does not supersede clinical judgement when assessing risk and providing recommendations to individuals. The Working Group on Adult Immunization Practice was appointed by the Infectious Diseases Society of Taiwan (IDST) and recommendations were drafted after a full literature review, using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system. The recommendations were reviewed and revised by expert review panels during a series of consensus meetings and endorsed by the IDST, Taiwan Association of Family Medicine, the Taiwanese Dermatological Association, the Taiwan Oncology Society, the Taiwan Society of Blood and Marrow Transplantation, the Transplantation Society of Taiwan, the Taiwan AIDS Society, and the Taiwan College of Rheumatology. This guidance describes the epidemiology of HZ and provides recommendations for HZ vaccination in adults with varying levels of risk, differing history of previous VZV infection and past varicella or zoster vaccinations.

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