Updated Recombinant Zoster Vaccine Recommendations Accepted by Physicians, but Knowledge Gaps, Financial Barriers Persist

Though most primary care physicians indicate a willingness to accept expanded recommendations from the Advisory Committee on Immunization Practice suggesting administration of recombinant zoster vaccine for adult patients who are immunocompromised, cost concerns and knowledge gaps limit vaccine delivery.

Although most primary care physicians welcome updated Advisory Committee on Immunization Practice (ACIP) recombinant zoster vaccine (RZV) recommendations, knowledge gaps, communication issues, and financial barriers prevent optimal vaccine delivery, according to a recent study published in the Journal of General Internal Medicine.

As of October 2021, ACIP updated its recommendations for RZV to include adults who are immunocompromised. Immunocompromised populations had previously been excluded from efficacy studies of RZV, but recent research led to the FDA expanding the indication for RZV to patients who are immunocompromised and 18 years of age or older.

Researchers sought to understand and assess practices, attitudes, and knowledge about RZV, barriers to recommending RZV, and the likelihood of recommending RZV to patients with various immunocompromising conditions among physicians, considering the updated recommendations.

They conducted a mail and internet-based survey of US general internists and family physicians from May through July 2020. The Vaccine Policy Collaborative Initiative, a survey mechanism to assess physician attitudes toward vaccine issues in collaboration with the CDC, was used to conduct the survey.

The overall response rate was found to be 66% (632/955), with results largely similar by specialty and presented together. Of these physicians, 67% were already recommending RZV to immunocompromised populations, including adults over 50 years of age with HIV, and 56% were already recommending RZV to those on recombinant human immune modulator therapy.

Most physicians reported they would be likely to recommend RZV to patients who are immunocompromised, though many indicated needing more direction on which patients who are immunocompromised should optimally receive RZV. Physicians often preferred for subspecialists to make the ultimate recommendation for the vaccine.

Nearly half of respondents stocked and administered RZV and referred patients elsewhere for vaccination (47%), however, 42% did not stock RZV, only referring patients. Only 4% did not stock, administer, or refer for RZV.

Among physicians who stocked RZV, 76% encouraged patients to return for a second dose by giving patients an appointment for the second dose, 51% conducted a reminder for patients to come back, and 41% relied on the patient to remember to return. The majority of respondents agreed that pharmacies do not inform them when RZV has been given (64%).

Although physicians were generally knowledgeable about RZV, 25% incorrectly thought that experiencing adverse effects from the first dose of RZV that interfere with normal activities was a reason not to receive a second dose. Additionally, physicians were less knowledgeable about RZV in relation to patients who are immunocompromised.

As 67% of respondents reported experiencing patients declining RZV due to cost, cost concerns were the top reported barrier to recommending RZV. Supply issues were a previous concern but have been largely resolved.

Of physicians who did not stock RZV, 70% reported that up-front vaccine purchase costs impacted their willingness to stock and recommend RZV and 59% reported inadequate reimbursement for vaccination as a deterrent, adding to financial barriers.

These results indicate a willingness among physicians to welcome updated ACIP RZV recommendations for adults who are immunocompromised. However, the authors assert that the existing knowledge gaps and financial barriers identified by the survey responses need to be addressed to optimize vaccination delivery.


Hurley LP, O’Leary ST, Dooling K, Anderson TC, Crane LA, Cataldi JR, et al. Survey of Physician Practices, Attitudes, and Knowledge Regarding Recombinant Zoster Vaccine. J Gen Intern Med. 2022. https://doi.org/10.1007/s11606-022-07721-z. Published July 6, 2022. Accessed July 11, 2022.