Vaccination against shingles increased among adults age 50 and older in the U.S. during the COVID-19 pandemic, but not equally across all population groups. That's the key finding from a new study my colleagues and I published in the journal Vaccine.
Author
- Jialing Lin
Research fellow in Health Systems, International Centre for Future Health Systems, UNSW Sydney
Shingles is caused by the reactivation of the varicella-zoster virus , the same virus that causes chickenpox. It leads to a painful rash and potentially serious complications - especially in older adults - such as persistent nerve pain, vision loss and neurological problems . While antiviral treatments can ease symptoms, vaccination is the most effective way to prevent shingles.
We analyzed nationally representative survey data from almost 80,000 adults age 50 and over between 2018 and 2022, collected by the Centers for Disease Control and Prevention to monitor the health of the U.S. population. The survey tracked vaccination rates in people of different ethnic backgrounds as well as other factors such as sex, household income and the presence of chronic conditions like diabetes and cardiovascular disease.
The uptake of shingles vaccines rose notably during the pandemic - from 25.1% of people for whom it is recommended in 2018-2019, to 30.1% during 2020-2022. We observed this overall increase across nearly all groups in our study.
We saw the greatest relative increases among groups that historically have had lower rates of shingles vaccination. These included adults ages 50-64, men, people from racial and ethnic minority groups such as non-Hispanic Black adults, those with lower household incomes, current smokers and people without chronic conditions like cancer or arthritis.
Why it matters
In the U.S., the CDC recommends shingles vaccination for all adults age 50 and older . However, uptake has been low, partly due to limited awareness, cost concerns and missed opportunities during routine health care visits.
The COVID-19 pandemic, while disruptive, may have inadvertently created new opportunities to improve adult vaccination uptake, particularly among groups with historically low uptake of the shingles vaccine. Factors contributing to this shift likely included heightened public awareness of the importance of vaccination, more frequent health care encounters, especially during COVID-19 vaccine rollouts , and the expanded availability of adult vaccines in pharmacies and primary care settings.
Replacing the older, less effective live attenuated zoster vaccine , called Zostavax, with the newer, non-live zoster vaccine, Shingrix, in 2020 also played a role. Public health campaigns that promoted co-administration of vaccines and launched targeted outreach to underserved populations further contributed to these gains.
However, major inequities persist. While shingles vaccination rates improved across the board, groups that had lower uptake before the pandemic continued to lag behind wealthier, non-Hispanic white populations with greater health care access. Overall, the vaccination rate for shingles is still low - below other vaccines such as the flu vaccine .
This gap reflects long-standing disparities in getting needed health care, which became even more prominent during the pandemic . It also highlights the need for fairer policies and customized outreach efforts to underserved communities that build trust and raise awareness about the health benefits of the shingles vaccine.
What still isn't known
Although the upward trend we observed is encouraging, several questions remain. For example, we could not tell from the survey data we worked with whether participants received both doses of the Shingrix vaccine. Both are needed for full protection against shingles .
Nor could we tell whether participants received the shingles vaccine alongside their COVID-19 vaccination. Receiving multiple vaccines at a single health care visit makes vaccination more convenient and may boost vaccine uptake by reducing the number of needed visits . Also unknown is how immunocompromised people fared during this period. Current guidelines recommend that immunocompromised adults regardless of age also receive the shingles vaccine, but the data only included adults age 50 and over.
Addressing these questions in future studies would help public health experts develop strategies to encourage more eligible people to receive the shingles vaccine.
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Jialing Lin does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
