2026 Southeastern Residency Conference

Background & Purpose:
Herpes zoster, commonly known as shingles, results from reactivation of latent varicella zoster virus and is associated with substantial morbidity, particularly among older adults and immunocompromised populations. Veterans receiving immunosuppressive therapy are at increased risk for severe disease, including postherpetic neuralgia and hospitalization. The recombinant herpes zoster vaccine (Shingrix) is a non-live, adjuvanted vaccine with efficacy exceeding 90% and is recommended for adults aged ≥50 years and immunocompromised adults aged ≥19 years. Despite these recommendations, vaccination rates among immunocompromised Veterans remain suboptimal. Within the Veterans Health Administration, Shingrix administration requires provider ordering and coordination of nurse clinic visits, which may introduce logistical barriers and contribute to delayed vaccination or incomplete series. Pharmacist-led interventions that incorporate patient education and care coordination may improve vaccine uptake by addressing hesitancy and streamlining the vaccination process.

Methods:
A pharmacist-led telephone intervention was conducted at the Ralph H. Johnson Veterans Affairs Health Care System in Charleston, South Carolina. Veterans prescribed immunosuppressive therapy who lacked one or both doses of the recombinant zoster vaccine were identified using a National VA Rheumatology Immunization Population Management Tool. Eligible patients were those enrolled in specialty clinics and prescribed a biologic, conventional synthetic, or targeted synthetic disease-modifying antirheumatic drug or systemic glucocorticoid. A random sample of 100 patients was selected. A PGY1 pharmacy resident conducted structured telephone outreach using motivational interviewing techniques to assess vaccine acceptance, explore concerns, and provide tailored education regarding shingles risk and vaccine safety. For patients who agreed to vaccination, orders for Shingrix and nurse clinic appointment were placed for one or both doses, if applicable. Vaccination outcomes and documented reasons for acceptance or refusal were tracked through the electronic medical record.

Results:
Sixty-six of 100 patients contacted agreed to receive Shingrix following pharmacist intervention, 30 declined, and 4 were previously vaccinated without documentation. Thirty-nine patients (59.1%) completed the vaccination series during the project period. Completion rates were higher among patients requiring one dose compared to two doses (72.2% vs 54.2%, p = 0.18). No significant differences in completion were observed by sex or ethnicity. Among patients who did not complete vaccination, over half were due to appointment-related barriers, including cancelled visits or failure to schedule.
Vaccine acceptance was most commonly associated with improved awareness, perceived benefit and risk reduction, and provider engagement that addressed questions, misinformation, and resolved logistical barriers. Patients frequently cited increased understanding of the need to complete the two-dose series and elevated herpes zoster risk in the setting of immunosuppressive therapy as key drivers of acceptance. Reasons for vaccine decline included vaccine hesitancy, low perceived risk, desire for additional time, information, or provider input, and scheduling barriers.

Conclusion:
Pharmacist-led outreach improved willingness to receive Shingrix among immunocompromised Veterans; however, series completion remained variable and was frequently impacted by logistical barriers. These findings highlight the importance of coordinated workflows and multidisciplinary collaboration to support vaccination beyond initial patient agreement. Addressing patient-specific concerns and streamlining scheduling processes can improve vaccine uptake and series completion while reinforcing the pharmacist’s role in vaccine stewardship.