Background: Patients with immune-mediated inflammatory diseases (IMID) exposed to immunosuppressive therapy are at increased risk of herpes zoster. As of March 2024, the French national health authority has updated the vaccination strategy against varicella zoster virus (VZV) and now recommends that immunocompromised persons aged 18 years and older be vaccinated with the recombinant VZV vaccine.

Objectives: We aimed to analyze the level of acceptance and potential concerns associated with VZV vaccination in patients with IMID.

Methods: The study consisted of an online questionnaire designed using an anonymous SurveyMonkey© process for data collection and processing. The study targeted adult patients with a self-reported diagnosis of IMID. Epidemiologic characteristics, VZV vaccine uptake and acceptance, and potential concerns regarding VZV vaccination were assessed. The survey was conducted between July 1 and October 31, 2024, and was distributed to patients attending medical visits or via mailing lists of 3 tertiary university centers in Paris and Lille, France. Addressing was optimized through the French Network for Autoimmune and Autoinflammatory Diseases (FAI2R) and the main French IMID patient associations. Partially completed questionnaires (< 60%) and questionnaires from patients who did not report a diagnosis of IMID were excluded from the analysis. Clinically relevant predictor variables, including sex, age, type of IMID, treatment received, history of herpes zoster and vaccination status against influenza and COVID-19 were used in a multivariable logistic regression model to identify those independently associated with acceptance of VZV vaccination with estimation of odds ratios (OR) and 95% confidence intervals (95%CI).

Results: A total of 756 adult patients participated in the study. Partially completed questionnaires (n=10) or questionnaires completed by patients who did not report IMID (n=23) were excluded, and 723 questionnaires were analyzed. Most patients (70%, n=508/723) were younger than 65 years and 80% (n=579/723) were female. Vasculitis, systemic lupus erythematosus, Sjögren’s syndrome, systemic sclerosis, inflammatory myositis and sarcoidosis accounted for 82% (n=592/723) of reported IMID. A history of herpes zoster was reported by 26% of patients (n=187/723). Two hundred and seventy patients (40%, n=270/682) were unaware that herpes zoster is more common in patients receiving immunosuppressive therapy. Four hundred thirty-two patients (63%, n=432/682) and 218 (32%, n=218/682) patients were unaware that herpes zoster can cause vision loss and long-lasting neuralgia, respectively. Nearly 75% (n=527/723) of patients currently or previously treated with corticosteroids or immunosuppressants were eligible for VZV vaccination but only 9 patients (2%, n=9/527) were vaccinated. Only 29% (n=211/723) of patients reported that they would accept vaccination against VZV while most of them were vaccinated annually against influenza (59%, n=423/723) and COVID-19 (54%, n=391/723) whenever recommended. In multivariable logistic regression analysis, acceptance of VZV vaccination was associated with age over 65 years (OR [95%IC]= 1.6 [1.1-2.4]), history of herpes zoster (OR [95%IC]= 1.9 [1.3-2.8]), and current vaccination against influenza (OR [95%IC]= 2.5 [1.6-3.9]) and COVID (OR [95%IC]= 2.2 [1.4-3.2]) (Table 1). The main concern of patients who were uncertain or unwilling to be vaccinated (n=512) was the risk of side effects (25%, n=127/512). Notably, 55% (n=280/512) of the hesitant patients stated that they would be more inclined to be vaccinated if the recommendation came from their treating physician.

Conclusion: In the high-risk IMID population, the proportion of patients willing to be vaccinated against VZV is very low. The fact that most hesitant patients would be likely to accept vaccination if recommended by their physician highlights the important role of health care professionals in promoting vaccination.

REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.