From awareness to action: Overcoming knowledge gaps and enhancing herpes zoster vaccination counseling among Chinese rheumatologists – Results from a nationwide survey

To assess the knowledge, attitudes, and practices (KAP) regarding herpes zoster (HZ) and its vaccination among rheumatologists in China. A nationwide cross-sectional survey was conducted between April 1 and May 31, 2025, using the Questionnaire Star online platform. The questionnaire assessed sociodemographic characteristics, knowledge of HZ and its vaccine (via a 13-item scale), attitudes and behaviors regarding vaccination, and willingness to disseminate information. Ordinal logistic regression was applied to identify associated factors of knowledge scores, while subgroup analyses were conducted to evaluate attitude-related factors. A total of 1,772 rheumatologists from a wide range of provinces participated (mean age: 41.4 y; 67.3% female). Regarding professional background, most held a master’s degree (44.1%), followed by a bachelor’s (38.9%) and doctoral degree (17.0%). Clinical titles were distributed as associate chief (31.3%), chief (26.4%), attending (26.2%), and junior physicians (16.0%). The median knowledge score was 7 (IQR: 6–9). Multivariable analysis revealed that higher regional GDP per capita (β = 0.020, p = .040), advanced education (β = 0.234, p < .001), and greater clinical seniority (β = 0.296, p < .001) were independently associated with higher knowledge scores. Clinically, physicians expressed significant concern primarily in three areas: HZ‘s potential to interfere with the underlying autoimmune inflammatory rheumatic diseases (AIIRDs) (89.0%), HZ-related complications (81.5%), and deterioration of patient quality of life (73.0%). Notably, 65.6% of respondents were concerned about all three aspects simultaneously. Regarding vaccination attitudes, 96.4% of respondents reported conditional support for vaccinating patients with AIIRDs, contingent upon pre-vaccination risk assessment and adherence to recommended protocols. Additionally, 80.0% favored prioritizing recombinant vaccines. Subgroup analyses indicated that higher clinical seniority was significantly associated with more supportive attitudes (p < .001). In clinical practice, 76.5% of physicians reported actively recommending HZ vaccination, although several barriers remained. The main reasons for not recommending included limited consultation time (52.2%), perception of low HZ incidence (42.8%), and lack of patient concern (31.3%). Targeted education and strengthened rheumatologist-led counseling may help address existing barriers, particularly among junior physicians in under-resourced settings. Such measures could contribute to improving HZ vaccination uptake and protection in patients with AIIRDs.