Missed opportunities for herpes zoster vaccination among older adults in the United States

INTRODUCTION: Recombinant zoster vaccine (RZV) uptake among older adults in the United States (US) is lower than other adult vaccines. The current study sought to identify characteristics of US adults unvaccinated against herpes zoster, despite being engaged in routine health-seeking behaviors. METHODS: This retrospective cohort study used administrative claims data from the Optum Research Database from 2016 to 2023 and involved commercial insurance enrollees and Medicare Advantage with Part D beneficiaries aged ≥50 years who had: (1) ≥1 claim for RZV; (2) ≥1 claim for an influenza, pneumococcal, tetanus-diphtheria, or tetanus-diphtheria-pertussis vaccine; or (3) a preventive care or evaluation and management visit but no evidence of these vaccinations. Multinomial logistic regression compared characteristics across these cohorts, and geospatial analysis visualized missed opportunities for RZV at county and Zone Improvement Plan (ZIP) code levels. RESULTS: Among 5,195,104 patients, 31.2% had received RZV, 40.5% had only received another included vaccine, and 28.3% had no evidence of any of the included vaccines. Compared to those who received RZV, those without evidence of RZV were more likely to be male, of Black race or Hispanic ethnicity, and have lower education levels and incomes, but were less likely to have an immunocompromising or autoimmune condition. Across the US, geographic clusters of areas with high rates of missed opportunities were prominent in the South and Northeast. CONCLUSION: Opportunities to increase awareness and uptake of RZV could be targeted at male patients, individuals from certain ethnic minority groups, and individuals with lower education and income. Strategies to address lower levels of RZV vaccination may consider focusing efforts in regions of the US where missed opportunities are prominent among adults who received vaccines other than RZV.