University of Wisconsin–Madison Medical College of Wisconsin

Racial and Ethnic Differences in Zoster Vaccine Uptake: A Cross-Sectional Study in a Veterans Health Administration Primary Care Clinic

Marvin J. Bittner, MD; Gia Thinh D. Truong, BS; Zachary A. Creech, BS

WMJ. 2021;120(3):168,170.

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Dear Editor:

Zoster vaccine uptake has been disappointing (34.5% of the target population) and marred by racial and ethnic disparities.1,2 However, studies of uptake generally have limitations. Most are survey-based (and subject to self-report bias) and based largely on the discontinued live vaccine (not the currently available recombinant vaccine).1,3 Furthermore, much of recent literature describes the situation 3 years ago when the recombinant vaccine was in shortage.1

These limitations raise a question: Do these racial and ethnic disparities persist? Insight into that question may be gleaned from a quality improvement project that we initiated to improve zoster vaccine uptake. Our baseline findings overcome those limitations. Our findings are current, record-based, and reflect the recombinant vaccine. Our findings are from a Veterans Health Administration clinic (where insurance and access are not barriers) and may shed light on the question of persistence of disparities, even when those barriers are absent.4

We queried the records of the Omaha primary care clinic of the Veterans Health Administration Nebraska-Western Iowa Health Care System for receipt of recombinant zoster vaccine since October 1, 2017. We included patients at least 50 years old on October 1, 2017 (close to the recombinant vaccine approval date) seen in the clinic October 1, 2020-July 5, 2021.

Our population of 10,323 was predominantly male (93.8%); 81.2% were non-Hispanic White, 10.7% were non-Hispanic Black, and 1.5% were Hispanic White. The prevalence of complete vaccination (2 doses) was 39.8% (females 34.7%, males 40.1%). Complete vaccination was 43.3% in non-Hispanic White patients, 33.8% in Hispanic White patients, and 24.9% in non-Hispanic Black patients. Receipt of at least 1 COVID-19 vaccine dose was 80.1%, 78.2%, and 82.2%, respectively.

A 39.8% prevalence of complete vaccination was higher than generally reported for zoster vaccine uptake.1,2 Conceivably, this could reflect our study population: individuals seen in a clinic with vaccine reminders, standing vaccine orders, onsite vaccine, and no charge for vaccine.4,5 Racial and ethnic disparities are consistent with most, but not all, of the literature.1,2

The contrast between zoster vaccine disparities and their absence with COVID-19 vaccine (for which awareness was extraordinarily high) supports the hypothesis that zoster vaccine disparities arise from disparities in awareness.2

Our baseline data confirm the appropriateness of our choice of zoster vaccine uptake as a quality improvement project, showing an opportunity for improving uptake and an opportunity to address factors other than insurance and access that account for racial and ethnic disparities.

  1. Terlizzi EP, Black LI. Shingles vaccination among adults aged 60 and over: United States, 2018. NCHS Data Brief, no 370. National Center for Health Statistics; 2020. Accessed August 19, 2021.
  2. Elekwachi O, Wingate LT, Clarke Tasker V, et al. A review of racial and ethnic disparities in immunizations for elderly adults. J Prim Care Community Health. 2021;12; 21501327211014071.doi:10.1177/21501327211014071
  3. Vogelsang EM, Polonijo AN. Social determinants of shingles vaccination in the United States. J Gerontol B Psychol Sci Soc Sci. 2021;gbab074. doi:10.1093/geronb/gbab074
  4. Straits-Tröster KA, Kahwati LC, Kinsinger LS, Orelien J, Burdick MB, Yevich SJ. Racial/ethnic differences in influenza vaccination in the Veterans Affairs healthcare system. Am J Prev Med. 2006;31(5):375-382. doi:10.1016/j.amepre.2006.07.018
  5. Brewer NT, Chapman GB, Rothman AJ, Leask J, Kempe A. Increasing vaccination: putting psychological science into action. Psychol Sci Public Interest. 2017;18(3):149-207. doi:10.1177/1529100618760521

Corresponding Author: Marvin J. Bittner, MD, Veterans Health Administration Nebraska-Western Iowa Healthcare System, 4101 Woolworth Ave (111D), Omaha, NE 68105; email; ORCID ID 0000-0002-2464-8819.
Author Affiliations: Veterans Health Administration Nebraska-Western Iowa Healthcare System, Omaha, Nebraska (Bittner); Creighton University School of Medicine, Omaha, Nebraska (Bittner, Truong, Creech).
Financial Disclosures: None declared.
Funding/Support: None declared.
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