# Assessing the Knowledge, Attitude, and Practice of Healthcare Workers on the Herpes Zoster Vaccine in Saudi Arabia: A Cross-Sectional Study

## TL;DR

This study examines healthcare workers' knowledge and attitudes about the shingles vaccine in Saudi Arabia, finding gaps in understanding and recommending it, especially for immunocompromised patients.

## Contribution

The study identifies specific knowledge gaps and barriers among Saudi healthcare workers regarding the recombinant zoster vaccine and proposes targeted strategies to improve vaccine uptake.

## Key findings

- Most healthcare workers correctly identified the RZV vaccine doses, but many incorrectly believed side effects from the first dose were a reason to skip the second.
- Many HCWs recommended the vaccine for healthy adults aged 18-49, outside of ACIP guidelines.
- Patient concerns about risk and side effects, along with limited vaccine availability, were major barriers to vaccine recommendation.

## Abstract

Background and objectives: Herpes zoster (HZ), known as shingles disease, has several complications that greatly affect elderly and immunocompromised people. Despite evidence for HZ vaccine efficiency and cost-effectiveness, the uptake of the HZ vaccine is lower than that of other common adult vaccines. Strong recommendations by healthcare workers (HCWs) for the HZ vaccine could increase vaccine uptake.

Aim: This study aimed to investigate HCWs' knowledge, attitude, and practice of the recombinant zoster vaccine (RZV) in Saudi Arabia and identify gaps and barriers in vaccine recommendation.

Materials and methods: A cross-sectional, questionnaire-based study was conducted in different hospitals in Riyadh, Saudi Arabia, between December 2023 and March 2024. An electronic self-administered validated questionnaire that assesses the knowledge, attitude, and practice of HCWs regarding the HZ vaccine was sent to all hospital staff. The collected data were organized, entered on an Excel sheet, and statistically analyzed using SPSS software. Pearson's chi-square test and Monte Carlo exact tests were used for data analysis.

Results: A total of 309 HCWs responded to the survey. Family physicians, infectious diseases doctors, and dermatologists are essential to recommend vaccines in Saudi Arabia. In particular, 264 (86.4%) HCWs correctly identified the doses of RZV. However, 148 (47.9%) incorrectly believed that side effects from the first dose were a valid reason not to receive the second dose. Most HCWs (n = 235, 76.1) agreed that they need more direction on which immunocompromised patients are eligible for the RZV vaccine. Most physicians recommend the vaccine for patient groups mentioned in the Advisory Committee on Immunization Practices (ACIP) recommendations. However, 85 (27.5%) recommended the vaccine for healthy adults aged 18-49 years. Ninety-nine (32%) patients declined the vaccine as they did not think they were at risk for developing shingles and 73 (23.6%) declined due to fears of immediate side effects. Among the strategies recommended to increase vaccine uptake are distributing zoster vaccine pamphlets to patients and having a hotline or a website available to discuss zoster vaccination, which were recommended by 255 (82.5%) and 235 (76.1%) HCWs, respectively.

Conclusions: Physicians in Saudi Arabia are generally knowledgeable about the HZ vaccine but need more guidance about ACIP recommendations. The patient reactions to the first dose, the limited vaccine availability, and the perception that RZV has not been adequately studied in immunocompromised patients are among the barriers to vaccine recommendation. Pamphlets regarding the HZ vaccine and a hotline or a website available for discussion about the vaccine are recommended strategies to increase vaccine uptake.