Herpes Zoster Vaccine Uptake and Active Campaign Impact, a Multicenter Retrospective Study in Italy

Abstract

The Herpes Zoster (HZ) vaccination has proven both safe and effective in alleviating conditions related to HZ, leading to significant cost savings in national healthcare and social systems. In Italy, it is recommended and provided free of charge to individuals aged 65 and older. To achieve broad vaccination coverage, alongside ordinary immunization campaigns, active and catch-up campaigns were implemented. This retrospective observational study aimed to observe the vaccination coverage achieved in the Romagna Local Health Authority (LHA) during the 2023 active campaign, with a secondary goal of assessing the impact of the 2022 catch-up campaign and the 2023 active campaign compared to ordinary campaigns. As of 3 July 2023, an overall vaccine uptake of 13.5% was achieved among individuals born in 1958, with variations among the four LHA centers ranging from 10.2% to 17.7%. Catch-up and active campaigns together contributed to nearly half of the achieved coverage in Center No. 1 and a quarter in Center No. 2. Notably, individuals born in 1957, not included in the Center No. 2 catch-up campaign, reached significantly lower vaccination coverage compared to other cohorts and centers. Analyzing the use of text messages for active campaigns, it was observed that cohort groups did not show substantial differences in text-message utilization for warnings. However, having relatives who had experienced HZ-related symptoms significantly reduced the reliance on text messages as warnings. These results highlighted how catch-up and active campaigns effectively increased vaccine coverage. Nevertheless, differences in uptake among different centers within the same LHA and the limited contribution of other information sources compared to text messages suggest the necessity of designing campaigns involving all available channels and stakeholders to maximize vaccine uptake.

Anti-Herpes Zoster Vaccination of Fragile Patients in Hospital Setting: A Nudge Intervention in Italy

“…This nudge intervention reveals strengths for vaccine adherence [43,44], such as the physical availability of the vaccine, a heightened perception of risk-especially among older individuals in this sample-a sense of collective responsibility [21] prevalent in younger individuals and those perceiving better health conditions and strong social relationships. Other variables from the 5C model are also present, including the degree of commitment to seeking information (less strenuous as provided on an ad hoc basis by physicians) and confidence in the vaccine and the treating health system.…”

“…The relational sphere, a nodal point of the micro-systemic level, appears crucial for the observed frail patients. Individuals who perceive greater support, especially from peers, exhibit good health, a low-stress perception, trust in collective knowledge, and demonstrate responsibility toward protecting others [21,58]. Overall, social support from various sources, including physicians, family members, and peers, emerges as an excellent protective factor that can be targeted for interventions.…”

“…These cultures shape users' cognitions, emotions, and personal motivations, influencing how physicians interact with patients. This understanding is significant for activating strategic and effective information campaigns [21,50,64], as well as nudge interventions. For instance, when dealing with frail patients with a higher level of education, there is a need to present information at multiple levels to facilitate decision-making.…”

“…In the vaccination field, various nudge interventions have been carried out worldwide, some of which have focused on the vaccination-promoting function produced by the form and/or content of the messages sent to patients. The content of the messages intersects with the heuristics and beliefs that underlie vaccine trust [15,21,22]. The form of the message (SMS, video, motivational cards, or other) is important as it activates different thought processes, such as Type 1 "automatic" or Type 2 "reflective" nudges [14][15][16][17][18][19][20].…”

“…Regarding contextual variables, vaccination adherence can also be influenced by vaccination campaigns and the information sources chosen by individuals [21,39,42,47]. Therefore, when communication is inadequate, it can negatively influence vaccine adherence and contribute to vaccine hesitancy [32].…”