To assess the knowledge, attitudes, and practices (KAP) regarding herpes zoster (HZ) and its vaccination among rheumatologists in China.

A nationwide cross-sectional survey was conducted between April 1 and May 31, 2025, using the Quetionnaire Star online platform. The questionnaire assessed sociodemographic characteristics, knowledge of HZ and its vaccine (via a 13-item scale), attitudes and behaviors regarding vaccination, and willingness to disseminate information. Ordinal logistic regression was applied to identify associated factors of knowledge scores, while subgroup analyses evaluate attitude-related factors. 

A total of 1,772 rheumatologists from a wide range of provinces participated (mean age: 41.4 years; 67.3% female). Regarding professional background, most held a master’s degree (44.1%), followed by a bachelor’s (38.9%) and doctoral degree (17.0%). Clinical titles were distributed as associate chief (31.3%), chief (26.4%), attending (26.2%), and junior physicians (16.0%). The median knowledge score was 7 (IQR: 6–9). Multivariable analysis revealed that higher regional GDP per capita (β = 0.020, p = 0.040), advanced education (β = 0.234, p < 0.001), and greater clinical seniority (β = 0.296, p < 0.001) were independently associated with higher knowledge scores. Clinically, physicians expressed significant concern primarily in three areas: HZ‘s potential to interfere with the underlying autoimmune inflammatory rheumatic diseases (AIIRDs) (89.0%), HZ-related complications (81.5%), and deterioration of patient quality of life (73.0%). Notably, 65.6% of respondents were concerned about all three aspects simultaneously. Regarding vaccination attitudes, there was strong endorsement (96.4%) for vaccinating AIIRD patients, contingent upon pre-vaccination risk assessment and adherence to recommended protocols. Additionally, 80.0% favored prioritizing recombinant vaccines. Subgroup analyses indicated that higher clinical seniority was significantly associated with more supportive attitudes (p < 0.001). In clinical practice, although 76.5% of physicians reported actively recommending HZ vaccination, significant barriers remained. The main reasons for not recommending included limited consultation time (52.2%), perception of low HZ incidence (42.8%), and lack of patient concern (31.3%).

 Targeted education and reinforced rheumatologist-led counseling are necessary to address existing barriers, particularly among junior physicians in under-resourced settings. These measures are critical for improving HZ vaccination coverage and patient protection in AIIRDs.