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

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.