Quantitative study of the knowledge, attitudes, and practices (KAP) towards herpes zoster (HZ) and HZ vaccination: Survey findings from a multi-country study in Asia (ZOASIS)

This study aimed to assess knowledge, attitudes, and practices toward herpes zoster (HZ) disease and vaccination and identify factors influencing HZ vaccination perceptions and behavior in adults ≥50 y of age (YOA) among the public and physicians in Hong Kong (HK), Singapore (SG), Republic of Korea (KR), and Taiwan (TW). A two-phase cross-sectional study was conducted in January–September 2022, including concept elicitation interviews (first phase, previously published) and a quantitative online survey (second phase, current article). The second phase involved a larger sample from the same target populations with different individuals. Participants in the second phase included: 1,970 adults ≥50 YOA, 203 adults aged 30–49 YOA with parents ≥50 YOA, and 220 physicians. Substantial knowledge gaps existed among the public about the causes, long-term impact, and risk factors for HZ. Awareness of HZ vaccine availability varied across locales (highest in KR [76%]; lowest in TW [35%]), and higher among individuals with a history of HZ (73%) than HZ-naïve individuals ≥50 YOA (49%). Key drivers of HZ vaccination included preventing disease/recurrence (44%) and long-term complications (41%), and physician recommendations (36%). Two-in-five individuals ≥50 YOA were recommended HZ vaccination. Most physicians agreed that recommending HZ vaccines to patients ≥50 YOA was important but reported initiating HZ vaccination conversations with 27.8% of their patients ≥50 YOA. Knowledge gaps surrounding HZ and HZ vaccination remain. Initiatives are needed to improve public awareness regarding the importance of HZ prevention. Physicians also play an important role in having proactive discussions about HZ prevention with their patients. This study assessed knowledge, attitudes, and practices toward shingles and its vaccination among the public and physicians in selected Asian locales (Hong Kong, Republic of Korea, Singapore, Taiwan) in two phases (Phase 1: concept elicitation interviews; Phase 2: online survey). We focus on Phase 2 results in 1,970 public and 220 physician respondents. The public had knowledge gaps about shingles symptoms, causes, impact, and risks. Across locales, 35–76% of all public respondents, 73% of public respondents with prior shingles, and 49% of public respondents without prior shingles were aware of shingles vaccines. Preventing shingles and long-term complications, and physician recommendations could motivate the public to get shingles vaccination. Although six in ten public respondents were aware of shingles vaccines, only two in ten were vaccinated against shingles. Three in four public respondents considered physicians as trusted information sources on shingles and its vaccination, but only two in five respondents aged ≥50 y had physicians recommend shingles vaccination. Physicians were knowledgeable about shingles symptoms, causes, impact, risks, and common complications. Prevalence and impact of shingles, patients’ other diseases, and government recommendations could motivate physicians to recommend shingles vaccination. Although nine in ten physicians saw the importance of recommending shingles vaccination to patients aged ≥50 y, only three in ten physicians discussed shingles vaccination with these patients due to time constraints, other priorities, and perceived low patient willingness for vaccination. Given these gaps about shingles and its vaccination, public education is important to encourage physician-patient conversations and shared decision-making about shingles vaccination.