Background/Purpose: Shingles is a painful cutaneous eruption due to the reactivation of latent Varicella zoster virus. Immunocompromised adults, due to a medical condition or immunosuppressive therapies, have a higher risk of shingles. In 2021, recombinant zoster vaccination was formally recommended by the ACIP for adults ages 18-50 who are immunocompromised. Despite this recommendation, zoster vaccination rates in the United States remain low. Our goal is to implement Plan, Do, Study, Act cycles to increase zoster vaccination rates in immunosuppressed patients aged > 18 years at the North Texas VA Medical Center Rheumatology clinic.

Methods: We identified Veterans > 18 years old with rheumatic disease on any immunosuppressive disease-modifying anti-rheumatic drug and their zoster vaccination status by reviewing charts of patients seen in the VA Rheumatology clinic from March 4, 2024 to May 30, 2024. To obtain baseline vaccination rates, we calculated the proportion of patients who were unvaccinated, partially vaccinated (received 1 of 2 vaccine doses) and fully vaccinated. We developed a process map and identified two areas for intervention (patient and provider education). We created posters for display in exam rooms to increase patient awareness, reviewed vaccination guidelines with rheumatology clinicians, and posted vaccination flowsheets in resident training/ onboarding documents and precepting rooms to improve provider awareness. We then reassessed the data from Jan 2, 2025 to March 31, 2025.

Results: We reviewed 752 charts and identified 390 eligible patients for baseline data. The average age was 60 and 79% were men. The most common diagnoses were spondyloarthropathy (39%) and rheumatoid arthritis (37%). At the time of the visit, 34% of patients were not vaccinated, 10% were partially vaccinated and 56% were fully vaccinated. Among those not fully vaccinated and eligible for vaccination 9% were counseled and immunized within one week, 26% were counseled but not immunized within one week, and 65% were not counseled. Post-intervention we reviewed 798 charts and identified 398 eligible patients. The average age was 60 and 81% were men, with similar rheumatologic diagnoses as baseline sample. At the time of visit, 36% were not vaccinated for zoster, 8% were partially vaccinated, and 56% were fully vaccinated. Among those not fully vaccinated and eligible for zoster vaccination 11% were counseled and immunized within one week of the visit, 46% were counseled but not immunized within one week, and 43% were not counseled.

Conclusion: Among patients eligible for zoster vaccination, our results show an increase in both the percentage of patients who were counseled at their visit and vaccinated within with one week. The percentage of fully vaccinated patients did not increase substantially. Following the above-mentioned interventions, zoster vaccination rates and counseling rates among immunosuppressed individuals improved in our outpatient rheumatology clinic.

Patient Characteristics

Change in Percentage Counseled for Vaccination

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increasing-zoster-vaccination-rates-in-immunosuppressed-veterans-at-the-north-texas-va-medical-center-rheumatology-clinic/