This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Enhancing Herpes Zoster Vaccination Rates Among Oncology Outpatients: Impact of an In-House Vaccination Initiative †
by
,
Alberto Giuseppe Agostara
1,2,*
,
Silvia Della Torre
1, 
Sara Di Bella
1,
Michela Pelliccione
1,
Paola Candido
1,
Valeria Smiroldo
1,
Davide Toniolo
1,
Francesca Zannier
1 and
Roberto Bollina
1 1
Department of Oncology, Ospedale G. Salvini—Rho—ASST Rhodense, Rho, 20017 Milan, Italy
2
Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
*
Author to whom correspondence should be addressed.
†
This paper is an extended version of our paper published “Bella, S.D.; Agostara, A.G.; Pelliccione, M.; Candido, P.; Torre, S.D.; Toniolo, D.; Zannier, F.; Galeassi, A.P.; Smiroldo, V.; Bel-loni, P.; et al. 1588P Interventions to improve Herpes Zoster (HZ) vaccination rate among cancer outpatients receiving sys-temic treatments: A single-center real-world experience. Ann. Oncol. 2024, 35, S957–S958. https://doi.org/10.1016/j.annonc.2024.08.1650”.
Cancers 2025, 17(21), 3502; https://doi.org/10.3390/cancers17213502 (registering DOI)
Submission received: 12 October 2025
/
Revised: 27 October 2025
/
Accepted: 30 October 2025
/
Published: 30 October 2025
(This article belongs to the Section Cancer Immunology and Immunotherapy)
Simple Summary
Cancer patients are more likely to develop shingles, a painful skin rash caused by the reactivation of the chickenpox virus. This risk increases because cancer and its treatments can weaken the immune system. A new vaccine, called the recombinant zoster vaccine, can effectively prevent shingles and its complications, but vaccination rates among cancer patients remain low. To address this problem, our oncology center introduced an in-house vaccination program that made the vaccine easily available to patients during their routine cancer care visits. This initiative greatly increased vaccination rates and was well accepted by patients. The results show that offering the vaccine directly within oncology services can remove practical barriers, improve patient protection, and serve as a model for other cancer centers aiming to enhance preventive care for their patients.
Abstract
Background: Herpes zoster (HZ) poses significant risks to immunocompromised individuals, particularly cancer patients receiving systemic therapies. The recombinant zoster vaccine (RZV, Shingrix®) provides strong and durable protection against HZ and its complications. Nevertheless, vaccination coverage remains low, mainly due to limited awareness among patients and healthcare providers and logistical barriers to vaccine access and delivery. Materials and Methods: We conducted a single-center quality improvement (QI) project to enhance RZV uptake among oncology outpatients receiving systemic therapy. Following the Plan–Do–Study–Act (PDSA) model, baseline HZ vaccination coverage was assessed, and an in-house vaccination campaign was implemented. Vaccination rates were monitored every two months over a 14-month period. Results: At baseline, only 5.4% (24/446) of patients had received RZV. After 14 months, 365 patients were evaluated for vaccination: 200 (55%) were vaccinated, 134 (37%) were ineligible, and 31 (8%) refused RZV. The overall vaccination rate increased from 5.4% to 44%. Reported adverse events were mild and primarily local reactions, confirming the vaccine’s favorable safety profile in this population. Conclusions: This real-world QI initiative demonstrates that an in-house vaccination strategy embedded within oncology services can substantially improve RZV coverage and patient engagement. The approach highlights the key role of oncology teams in leading preventive interventions for immunocompromised patients. By integrating vaccination into routine cancer care, institutions can overcome traditional organizational barriers and align with current ASCO and ESMO recommendations for comprehensive patient protection.
