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. 2025 Jul 1.
doi: 10.1007/s13187-025-02668-1. Online ahead of print.

Awareness, Attitudes, and Practice Related to Herpes Zoster and its Vaccines among Patients with Malignant Cancers: A Multi-Center Cross-Sectional Study in China

Pan Xiaoyuan  1   2 , Zhu Xinyu  3 , Dong Zhengbang  4
Affiliations

Awareness, Attitudes, and Practice Related to Herpes Zoster and its Vaccines among Patients with Malignant Cancers: A Multi-Center Cross-Sectional Study in China

Pan Xiaoyuan et al. J Cancer Educ. .

Abstract

To assess the awareness, attitudes, and practice related to Herpes Zoster (HZ) and its vaccines among cancer patients from two tertiary hospitals in China, and explore the factors influencing the perceived necessity of vaccination against HZ. This was a multi-center cross-sectional study involving cancer patients from two tertiary hospitals in China from January to April 2024. A self-designed questionnaire was used to survey the baseline characteristics, awareness, attitudes and practice about HZ and its vaccines, and factors influencing the perceived necessity of vaccination against HZ. A total of 392 cancer patients were included in the study, with an overall awareness score towards HZ and its vaccines of 4.79 ± 2.36 points, and an overall attitude score of 11.69 ± 2.32 points. The awareness score towards HZ and its vaccines was negatively correlated with male gender (β = -0.51, P < 0.001), 50-59 years of age (β = -1.43, P = 0.001), ≥ 60 years of age (β = -1.84, P < 0.001), and divorced/widowed (β = -1.29, P = 0.018). It was positively correlated with higher education level (β = 0.62, P = 0.035), annual household income (AHI) ≥ 100,000-150,000 RMB (β = 0.89, P = 0.012), AHI > 150,000 RMB (β = 1.64, P = 0.002), urban residency (β = 0.72, P = 0.002), diabetes (β = 1.41, P = 0.001), and history of chickenpox (β = 0.56, P = 0.011). The attitude score towards HZ and its vaccines was negatively correlated with male gender (β = -0.67, P = 0.006) and uncertain history of chickenpox (β = -1.2, P = 0.005), while positively correlated with AHI > 150,000 RMB (β = 1.89, P < 0.001), history of HZ (β = 0.66, P = 0.013), and information source from community healthcare providers (β = 1.7, P < 0.001). The HZ vaccination rate was only 1.79% in the overall cohort, and 3.68% among older adults aged ≥ 50 years. Nearly half of participants (49.17%) ignored the significance of vaccination against HZ mainly due to the unawareness of HZ vaccine availability, and concerns about side effects. Misconceptions about an increased susceptibility to HZ in immunocompromised individuals, complications and prevention of HZ were the dominant factors influencing the perceived necessity of vaccination. While possessing a strong belief in the vaccine efficacy against HZ, the vaccination rate remains extremely low in Chinese cancer patients due to a low awareness of HZ and its vaccines. The education of vaccination against HZ by community healthcare providers is a promising way to increase the willingness to get vaccinated, particularly in the elderly, and those with low educational levels, and low AHI.

Keywords: Cancer patients; Cross-sectional study; Herpes Zoster; Vaccine.

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Conflict of interest statement

Declarations. Consent: All participants in our study signed informed consent forms, ensuring the ethical integrity of our research. Copyright statement: The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, a worldwide licence to the Publishers and its licensees in perpetuity, in all forms, formats and media (whether known now or created in the future), to i) publish, reproduce, distribute, display and store the Contribution, ii) translate the Contribution into other languages, create adaptations, reprints, include within collections and create summaries, extracts and/or, abstracts of the Contribution, iii) create any other derivative work(s) based on the Contribution, iv) to exploit all subsidiary rights in the Contribution, v) the inclusion of electronic links from the Contribution to third party material where-ever it may be located; and, vi) licence any third party to do any or all of the above. Conflict of interests: We have read and understood policy on declaration of interests and declare that we have no conflict of interests.

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