Varicella-zoster virus immunity and self-reported history among healthcare workers in Greece

Ilias E. Dimeas; Anargiros Mariolis; Vasiliki Sachtaridou; Panagiota Soulioti; Erasmia Rouka; George D. Vavougios; Georgios M.  Hagjigeorgiou; Zoe Daniil; Konstantinos I. Gourgoulianis; Dimitrios Papagiannis

doi:10.22605/RRH10952

Original Research

Varicella-zoster virus immunity and self-reported history among healthcare workers in Greece

AUTHORS

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Ilias E. Dimeas^1,2 MD, Clinical Fellow *

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Anargiros Mariolis³

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Vasiliki Sachtaridou²

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Panagiota Soulioti³

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Erasmia Rouka⁴ Professor

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George D. Vavougios⁵

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Georgios M. Hagjigeorgiou⁵ Professor

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Zoe Daniil² Professor

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Konstantinos I. Gourgoulianis² Professor

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Dimitrios Papagiannis^5,6 Associate Professor

AFFILIATIONS

¹ School of Medicine, University College Dublin, Dublin, Ireland

² Department of Respiratory Medicine, University Hospital of Larissa, Larissa, Thessaly, Greece

³ Department of Primary Care, Health Center of Areopolis, Areopolis, Greece

⁴ Department of Nursing, School of Health Sciences, University of Thessaly, Larissa, Greece

⁵ Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus

⁶ Public Health & Adults Immunization Lab, Department of Nursing, University of Thessaly, Larissa, Greece

ACCEPTED: 29 May 2026

Early Abstract:

Background & Aim: Varicella-zoster virus (VZV) remains an occupational hazard for healthcare workers (HCWs), yet serological screening and catch-up vaccination policies are inconsistently implemented. We aimed to estimate VZV IgG seroprevalence and vaccination coverage among Greek HCWs, assess the validity of self-reported immunity, and explore the feasibility and yield of brief cognitive screening in this population.
Design & Methods: In this cross-sectional study, physicians, nurses, paramedical and administrative staff completed a standardized questionnaire on demographics, varicella/herpes zoster history and vaccination. Serum VZV IgG was measured using a commercial ELISA. Agreement between self-reported immunity and serostatus was quantified with Cohen’s κ. Cognitive performance was assessed with the General Practitioner Assessment of Cognition (GPCOG) in an exploratory analysis.
Results: Seventy-four HCWs (mean age 40.8 years; 67.6% female) were enrolled; 77.0% reported prior varicella vaccination and 4.1% reported herpes zoster vaccination. VZV IgG seroprevalence was 93.2%, leaving 6.8% seronegative. Self-reported immunity showed high crude agreement but no concordance beyond chance with serostatus (κ = 0.03), with 14.9% underestimating and 5.4% overestimating their immunity. GPCOG Step-1 scores were strongly skewed to the maximum (mean 8.77/9), yielding marked ceiling effects and no detectable association with VZV markers in exploratory analyses.
Conclusion: In this sample of Greek HCWs, VZV immunity was high but not universal, and self-reported history was an unreliable proxy for serological status. Our findings support serological screening and targeted vaccination of susceptible HCWs for infection-control purposes. Cognitive screening with GPCOG in this relatively young workforce showed minimal discrimination and should be considered exploratory. These findings are particularly relevant to rural and remote health services, where limited staffing flexibility can magnify the impact of susceptible healthcare workers on service continuity and infection control.
Keywords: healthcare workers, healthcare workforce, herpes zoster, rural health services, seroprevalence, vaccination coverage, varicella-zoster virus.