(A-341) Incidence of herpes zoster and vaccination rates in VA long-stay nursing home residents

Background: Herpes zoster (hereafter “shingles”) is associated with substantial morbidity, especially in nursing home residents of advanced age and weakened immune systems. Few studies have documented the epidemiology of shingles or vaccination uptake in the nursing home population.

Objectives: Our objective was to describe the incidence of shingles and shingles vaccination rates in US Veteran’s Affairs (VA) nursing home residents.

Methods: We conducted a cohort study of long-stay (stays of 90 days or more) Veterans 50 years and older admitted to a VA nursing home (2017-2024). Following residents forward from the nursing home admission date (index date), we measured the incidence of shingles diagnoses (ICD-10 diagnostic code or laboratory result) and vaccination exposure (recombinant zoster vaccine [RZV] and zoster vaccine live [ZVL]) using linked VA electronic health records and administrative claims data. Residents were followed from admission up to either 4 years, death or facility discharge. The cumulative incidence of shingles at each year of follow-up was the primary outcome.

Results: We identified 16,804 Veterans admitted to a VA nursing home with a 90+ day length of stay during the study period. Residents had a mean age of 75 years, 96% male and median length of stay of 180 days. Prior to admission, 5,884 (35.0%) were vaccinated with ZVL and 3,847 (22.9%) with RZV. In the nursing home, 177 (1.1%) were vaccinated with ZVL and 907 (5.4%) with RZV, while 129 HZ cases were observed (0.8%) overall, with a cumulative incidence of 1.5%, 2.3%, 3.3% and 3.9% at 1-4 years of follow-up respectively.

Conclusions: Shingles risk was approximately 1% per resident per year in the nursing home, and vaccination rates were low. There is a significant opportunity to improve zoster vaccination uptake and prevent herpes zoster among nursing home residents.