{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:13:25Z","timestamp":1783491205574,"version":"3.55.0"},"reference-count":33,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: Herpes zoster (HZ), commonly known as shingles, and post-herpetic neuralgia (PHN) represent growing public health concerns, particularly among older adults. Despite the established efficacy of the herpes zoster vaccine (HZV), global uptake remains suboptimal. Objectives: This scoping review maps evidence from Saudi Arabia evaluating the baseline knowledge, awareness, attitudes, acceptance, hesitancy, and clinical uptake of the HZV among general adults, high-risk populations, and healthcare workers (HCWs). Methods: The JBI and PRISMA-ScR methodological frameworks were strictly adhered to during mapping. Eligible sources included peer-reviewed, observational cross-sectional studies conducted in Saudi Arabia and published in English between 2022 and 2026. The search was conducted across PubMed, Scopus, Web of Science, and Google Scholar. Data were systematically extracted and charted using a standardized digital piloting framework to capture study characteristics (author, year, and region), sample sizes, target populations, knowledge percentages, actual vaccine uptake rates, and self-reported barriers. Results: Out of 25 retrieved records, 19 unique primary studies were mapped. Public knowledge of HZ complications and vaccine eligibility criteria was consistently low to moderate, falling below 50% across most cohorts. Conversely, while verbal willingness to receive the vaccine was highly favorable (ranging from 60% to 75%), a profound \u201cintention\u2013behavior gap\u201d was observed, with actual clinical uptake being below 10%. Key barriers included a lack of public health campaigns, safety concerns regarding reactogenicity, online misinformation, and a lack of proactive provider communication. For HCWs, barriers included unclear local guidelines and a lack of workplace mandates. Ultimately, a proactive physician recommendation was identified as the single most powerful clinical facilitator, increasing vaccine acceptance by over 80% across all cohorts. Conclusions: While the shingles vaccine is now distributed completely free across Saudi Arabia, high public willingness has not translated into actual vaccination rates (10%) due to low public awareness of disease severity. Free vaccine availability alone is insufficient; primary care systems must shift from a passive delivery model to an active, provider-driven framework to successfully close this gap<\/jats:p>","DOI":"10.3390\/vaccines14070565","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:55:11Z","timestamp":1782780911000},"page":"565","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Knowledge, Awareness, Attitudes, Acceptance, and Uptake of the Herpes Zoster Vaccine in Saudi Arabia: A Scoping Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3530-1519","authenticated-orcid":false,"given":"Howeida","family":"Abusalih","sequence":"first","affiliation":[{"name":"Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"ref_1","unstructured":"Habif, T.P., Griggs, D.J., Campbell, M.S., and Khachemoune, A.Z. (2018). Skin Disease: Diagnosis and Treatment, Elsevier. [4th ed.]."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1093\/cid\/ciw296","article-title":"Increasing incidence of herpes zoster over a 60-year period from a population-based study","volume":"63","author":"Kawai","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","unstructured":"World Health Organization (2019). Ten Threats to Global Health in 2019, World Health Organization. Available online: https:\/\/www.who.int\/news-room\/spotlight\/ten-threats-to-global-health-in-2019."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Alaamri, O., Okmi, E.A., and Suliman, Y. (2022). Vaccine Hesitancy in Saudi Arabia: A Cross-Sectional Study. Trop. Med. Infect. Dis., 7.","DOI":"10.3390\/tropicalmed7040060"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"6433","DOI":"10.4103\/jfmpc.jfmpc_933_22","article-title":"Clinical and epidemiological aspects of herpes zoster disease in a primary care setting in Riyadh, Saudi Arabia: A retrospective cohort study","volume":"11","author":"Binsaeedu","year":"2022","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s40794-023-00202-z","article-title":"Herpes zoster vaccine awareness and acceptance among adults in Saudi Arabia: A survey-based cross-sectional study","volume":"9","author":"AlMuammar","year":"2023","journal-title":"Trop. Dis. Travel Med. Vaccines"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"239","DOI":"10.4103\/jfmpc.jfmpc_1978_24","article-title":"Knowledge, attitude, and practice toward herpes zoster vaccination among the general population aged 50 years or above in Riyadh, Saudi Arabia: A cross-sectional study","volume":"15","author":"Alrufayyiq","year":"2026","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_8","unstructured":"Saudi Press Agency (2026, May 22). \u201cHealth\u201d Announces the Availability of a Vaccine for Shingles in Primary Health Care Centers, Available online: https:\/\/www.spa.gov.sa\/2388337."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"AlSaif, H.I., AlMuaawi, L., Alsenani, S., Aldalaqan, N., Mulia, Y., Alqazlan, F., Alsheikh, S., Alsaidan, M., Alshehri, N.A., and Alrasheed, A.A. (2025). Uptake, Willingness, and Determinants of Herpes Zoster Vaccination in Adults with Chronic Diseases in Riyadh, Saudi Arabia. Healthcare, 13.","DOI":"10.3390\/healthcare13192495"},{"key":"ref_10","first-page":"e50329","article-title":"Knowledge About the Herpes Zoster (HZ) Vaccine and Its Acceptance Among the Population in Al-Ahsa City in the Kingdom of Saudi Arabia","volume":"15","author":"Bohamad","year":"2023","journal-title":"Cureus"},{"key":"ref_11","first-page":"e101941","article-title":"Awareness Level of Herpes Zoster Infection Among the Residents of Jeddah, Saudi Arabia","volume":"18","author":"Algarni","year":"2026","journal-title":"Cureus"},{"key":"ref_12","first-page":"11","article-title":"Knowledge, attitudes, and practices of herpes zoster vaccination in Al Ahsa","volume":"4","author":"Alfandi","year":"2024","journal-title":"J. Healthc. Sci."},{"key":"ref_13","first-page":"5","article-title":"Awareness, attitudes, and acceptance of herpes zoster vaccination among adults in Saudi Arabia: A cross-sectional study","volume":"2","author":"Alatawi","year":"2025","journal-title":"GRS J. Multidiscip. Res. Stud."},{"key":"ref_14","first-page":"e77302","article-title":"Assessing the Knowledge, Attitude, and Practice of Healthcare Workers on the Herpes Zoster Vaccine in Saudi Arabia: A Cross-Sectional Study","volume":"17","author":"Moustafa","year":"2025","journal-title":"Cureus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"89","DOI":"10.51847\/ktSTd3IP0K","article-title":"Knowledge and Perceptions Regarding Herpes Zoster and its Vaccine in Saudi Arabia: A Community-Based Survey","volume":"16","author":"Zeried","year":"2025","journal-title":"J. Biochem. Technol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"895","DOI":"10.4103\/jfmpc.jfmpc_615_25","article-title":"Assessment of populations\u2019 knowledge and willingness to receive Herpes Zoster Vaccine: A cross-sectional study from Qassim Region, Saudi Arabia","volume":"15","author":"Alolayan","year":"2026","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e44356","DOI":"10.1097\/MD.0000000000044356","article-title":"Awareness and uptake of herpes zoster vaccine among patients with diabetes mellitus in the Aseer Region, Saudi Arabia: A cross-sectional study","volume":"104","author":"Alamri","year":"2025","journal-title":"Medicine"},{"key":"ref_18","first-page":"e66301","article-title":"Practices, Attitudes, and Knowledge Regarding Zoster Vaccine Among Family Medicine Residents in Riyadh, Saudi Arabia","volume":"16","author":"Alahmari","year":"2024","journal-title":"Cureus"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Aromataris, E., and Munn, Z. (2020). Chapter 11: Scoping reviews. JBI Manual for Evidence Synthesis, JBI.","DOI":"10.46658\/JBIRM-20-02"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation","volume":"169","author":"Tricco","year":"2018","journal-title":"Ann. Intern Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1080\/1364557032000119616","article-title":"Scoping studies: Towards a methodological framework","volume":"8","author":"Arksey","year":"2005","journal-title":"Int. J. Soc. Res. Methodol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/1748-5908-5-69","article-title":"Scoping studies: Advancing the methodology","volume":"5","author":"Levac","year":"2010","journal-title":"Implement. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan\u2014A web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_24","first-page":"e68726","article-title":"Knowledge of Herpes Zoster Virus and Its Vaccines Among Older Adults in Jazan Province, Saudi Arabia: A Cross-Sectional Study","volume":"16","author":"Alhazmi","year":"2024","journal-title":"Cureus"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Al-Metwali, B., Al-Raddadi, R., and Al-Qarni, A. (2023). Acceptability of Herpes Zoster Vaccination among Patients with Diabetes: A Cross-Sectional Study in Saudi Arabia. Vaccines, 11.","DOI":"10.3390\/vaccines11030651"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"90","DOI":"10.47310\/jpms2026150513","article-title":"Herpes Zoster Vaccine Awareness and Acceptance among General Population in Northern Border Region: A Cross-Sectional Study","volume":"15","author":"Gouda","year":"2026","journal-title":"J. Pioneer. Med. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e70115","DOI":"10.1002\/jgf2.70115","article-title":"Herpes Zoster Vaccine Awareness and Uptake Among Older Adults in Saudi Arabia: Insights for Public Health, Preventive Medicine, and Primary Care Practice","volume":"27","author":"Aldhawyan","year":"2026","journal-title":"J. Gen. Fam. Med."},{"key":"ref_28","first-page":"2242","article-title":"Knowledge, Attitude, and Practice Regarding Herpes Zoster Vaccination Among Primary Healthcare Patients in the Central Region of Saudi Arabia: A Cross-Sectional Study","volume":"8","author":"Almalki","year":"2024","journal-title":"Int. J. Med. Dev. Ctries."},{"key":"ref_29","first-page":"115","article-title":"Adult immunization gaps and policies across the Gulf Cooperation Council (GCC) states: A regional synthesis","volume":"14","year":"2024","journal-title":"Middle East J. Public Health"},{"key":"ref_30","unstructured":"European Centre for Disease Prevention and Control (ECDC) (2024). Shingles Prevention Frameworks and the Chronic Disease Implementation Paradox in Older Populations, ECDC."},{"key":"ref_31","unstructured":"Centers for Disease Control and Prevention (2026, May 22). Shingles Vaccination. U.S. Department of Health and Human Services, Available online: https:\/\/www.cdc.gov\/shingles\/vaccines\/index.html."},{"key":"ref_32","unstructured":"World Health Organization (2023). Global Guidance for Adult Immunization Curricula in Medical Training, WHO Press. Available online: https:\/\/terrance.who.int\/mediacentre\/data\/sage\/SAGE_Docs_Ppt_Apr2014\/SAGE_Yellow_Book_Apr_2014.pdf."},{"key":"ref_33","unstructured":"Federation of Primary Care Practitioners (2025). The role of clinical activation and automated audits in transforming adult preventive healthcare metrics. Glob. Health Policy Rev., 19, 210\u2013225."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/7\/565\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:19:15Z","timestamp":1783487955000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/7\/565"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":33,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["vaccines14070565"],"URL":"https:\/\/doi.org\/10.3390\/vaccines14070565","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,26]]}}}