TOPLINE:

Uptake of the recombinant zoster vaccine (RZV) among adults with rheumatic diseases in the 20 months following the updated 2021 recommendations ranged from 7% to just more than 10% across conditions. Among those who received an initial dose, more than 60% completed the two-dose series within 6 months, though younger adults were less likely to initiate vaccination than adults aged 65 years or older.

METHODOLOGY:

• Researchers conducted a mixed-methods study (April 2021 to June 2023) combining a retrospective cohort analysis of open-source claims data with qualitative interviews of rheumatologists to evaluate RZV uptake among adults with rheumatic diseases in the US.
• They included 548,426 adult patients (mean age, 58.7 years; 79.1% women) with ankylosing spondylitis (n = 18,278), rheumatoid arthritis (n = 346,010), psoriatic arthritis (n = 53,240), or systemic lupus erythematosus (n = 130,898).
• Claims data linked to data on healthcare provider profiles and information on social determinants of health were utilized to identify patient characteristics associated with RZV receipt.
• Qualitative analysis involved semistructured interviews with 15 rheumatologists (mean age, 52 years; 67.0% White individuals; 60.0% men) from April to June 2024, which were thematically analyzed to characterize vaccination practices and perceived barriers to RZV administration.

TAKEAWAY:

• Overall RZV uptake among individuals without prior vaccination showed that in the 20 months after the 2021 updated recommendations, 8.7% of patients with ankylosing spondylitis, 10.4% with rheumatoid arthritis, 9.9% with psoriatic arthritis, and 7.0% with systemic lupus erythematosus received at least one dose of RZV. Series completion rates at 6 months were 61.9%, 63.0%, 62.2%, and 61.4% for patients with the respective conditions.
• Patients with ankylosing spondylitis had higher odds of RZV uptake than those with other rheumatic conditions (odds ratio [OR], 1.13; 95% CI, 1.05-1.21), whereas patients with systemic lupus erythematosus had lower odds of uptake (OR, 0.86; 95% CI, 0.82-0.89).
• Adults aged 19-29 years (OR, 0.10; 95% CI, 0.08-0.12), 30-39 years (OR, 0.11; 95% CI, 0.09-0.12), or 40-49 years (OR, 0.27; 95% CI, 0.25-0.28) had substantially lower odds of vaccination than those aged 65 years or older, whereas adults aged 60-64 years had higher odds than those aged 65 years or older (OR, 1.13; 95% CI, 1.10-1.17).
• The interviewed rheumatologists advocated for vaccination, but some viewed their role as primarily advisory; financial concerns, lack of formal vaccination tracking systems and reminder processes, and insufficient education for both providers and patients were barriers to RZV vaccination.

IN PRACTICE:

“Addressing barriers related to education and awareness, as well as improving workflow processes and information exchange, could support future improvement in [herpes zoster] prevention among patients with rheumatic disease,” the authors of the study wrote.

SOURCE:

The study was led by Justin Carrico, GSK, Philadelphia. It was published online on March 23, 2026, in ACR Open Rheumatology.

LIMITATIONS:

The uptake estimates did not represent cumulative uptake since the availability of RZV. Information about vaccination status may have been incomplete, with potential for misclassification or missing data. Patients with rheumatic disease were identified using baseline data, raising the possibility that some may not have remained immunosuppressed throughout the study period. The study did not analyze RZV uptake across all rheumatic diseases. 

DISCLOSURES:

This study was supported by GSK. Support for third-party writing assistance was funded by GSK in accordance with Good Publication Practice 2022 guidelines. Some authors reported receiving funding from GSK and/or IQVIA for the study, having stock or stock options with GSK or Pfizer, and/or receiving grants or having other ties with multiple companies. Four authors reported being IQVIA employees and two authors reported employment with GSK.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.