Background: Approximately one million new cases of shingles (herpes zoster [HZ]), a severely painful and debilitating disease caused by reactivation of varicella-zoster virus (VZV), occur in the United States each year. HZ incidence increases with age, especially after age 50. A vaccine to prevent HZ and its sequelae was licensed in May 2006 for those aged 60 years or older, making it the first new vaccine targeted to this age group in many years. In October 2006 the Advisory Committee on Immunization Practices (ACIP) recommended HZ vaccination of persons aged > or =60 years; these recommendations were published in 2008. We examined HZ vaccination coverage among persons aged > or =60 years in the U.S. in 2007, and evaluated factors affecting the uptake of HZ vaccine in this population.
Methods: Data from the 2007 National Immunization Survey-Adult (NIS-Adult) restricted to individuals aged > or =60 years were analyzed using SUDAAN software to estimate national HZ vaccination coverage, and reasons for not receiving the HZ vaccine. We used multivariable logistic regression analysis to identify factors independently associated with HZ vaccination.
Results: Of 3662 respondents, 1.9% (95% confidence interval=1.3%, 2.8%) reported having received the HZ vaccine. A total of 72.9% of respondents were unaware of the HZ vaccine but 77.8% stated that they would accept HZ vaccination if their doctor recommended it. Of the remaining 556 respondents, key reasons reported for not accepting HZ vaccine included 'vaccination not needed' (34.8%), 'not at risk' (12.5%), and 'don't trust in doctors or medicine' (9.5%).
Conclusions: Soon after its availability in the United States, coverage among adults recommended to receive the HZ vaccine was low. Our data provide evidence that the lack of patient awareness and of physician recommendations were barriers to vaccine uptake.