From Awareness to Action: Addressing Knowledge Barriers and Promoting Herpes Zoster Vaccination in Chinese Rheumatic Disease Patients

Abstract

Aim: To investigate the knowledge of and attitudes towards herpes zoster (HZ) and its vaccination, as well as the vaccination status of Chinese patients with rheumatic disease. Method: A face-to-face questionnaire survey was conducted among patients visiting the Department of Rheumatology and Clinical Immunology, Peking University First Hospital from 1 March to 30 April 2024. Information on HZ infection and vaccination status was recorded. The questionnaire assessed their knowledge of HZ and the HZ vaccine with nine questions, scoring one point for each correct answer, resulting in a total score ranging from zero to nine. Attitudes toward HZ and vaccines were measured by a five-point Likert scale, with scores ranging from one ("strongly disagree") to five ("strongly agree"). Factors associated with knowledge and attitude scores were analyzed using an ordinal logistic regression. Results: A total of 1036 patients completed the questionnaire, with a mean age of 47.1 years, and 79.3% were females. The three most prevalent diseases were systemic lupus erythematosus (32.4%), rheumatoid arthritis (26.3%) and Sjögren's syndrome (9.9%). A total of 243 patients (23.5%) reported a history of HZ or current HZ infection. Only 2.0% of the patients had been vaccinated, while 51.0% expressed willingness to be vaccinated in the future. The median knowledge score was four (2, 5) (ranging from zero to nine), and the median attitude score was 19 (17, 20) (ranging from 5 to 25). Factors associated with higher knowledge scores included being female (β = 0.448, p = 0.001), having a higher educational level (β = 0.355, p < 0.001), having a higher monthly income (β = 0.191, p = 0.008) and having comorbidities (β = 0.275, p = 0.023). Factors associated with higher attitude scores included being female (β = 0.279, p = 0.035), having a higher monthly income (β = 0.196, p = 0.037) and possessing a higher education level (β = 0.310, p = 0.045). Conclusions: Patients with rheumatic disease in China exhibit a low level of cognition regarding HZ as well as its vaccine, and the vaccination rate is very low. To improve the understanding and prevention awareness of HZ, health education should be intensified, particularly targeting males, those with lower levels of education and lower-income patients.

Keywords: attitudes; herpes zoster; knowledge; rheumatic disease; survey; vaccines.

Figure 1

Sociodemographic and general characteristics of the participants: (A) type of rheumatic diseases (including SLE, RA, pSS and other rheumatic diseases); (B) type of comorbidities (with hypertension, hyperlipidemia, diabetes and other comorbidities); (C) educational level (junior high school and below, high school or vocational secondary education, college or undergraduate degrees, and postgraduate and above); (D) monthly income (including 2000 CNY and below, 2000–5000 CNY, 5000–10,000 CNY and 10,000 CNY and above). CNY, China Yuan.

Figure 2

The primary factors influencing patients’ willingness to receive herpes zoster (HZ) vaccination. Bar graph depicting the primary reasons influencing patients’ willingness to receive the HZ vaccine. Each bar represents a distinct reason, and the corresponding percentage reflects the proportion of participants who gave that reason.

Figure 3

How did participants’ attain information on herpes zoster and its vaccines? Radar chart illustrating the distribution of knowledge acquisition channels among participants. Each axis represents a specific channel, and the corresponding value indicates the percentage of patients who reported obtaining HZ-related information through that channel.