# From Knowledge to Action: Enhancing Herpes Zoster Vaccine Uptake in Diabetic Patients Through Targeted Interventions

## TL;DR

This study shows that targeted interventions increased Herpes Zoster vaccine uptake among diabetic patients in Romagna, with some groups showing greater improvements than others.

## Contribution

The study demonstrates the effectiveness of combined patient and provider interventions in improving vaccine coverage among diabetic patients.

## Key findings

- Vaccine coverage increased from 7.4% in 2023 to 11.1% in 2024 across all sociodemographic groups.
- Males and Italian citizens showed higher vaccination rates, while foreign citizens had a greater proportional increase.
- Age-targeted campaigns were most effective for individuals born after 1958.

## Abstract

Background/Objectives: Vaccinations are a cost-effective strategy to reduce morbidity and mortality from infectious diseases, particularly in individuals with diabetes mellitus (DM). Despite recommendations for routine vaccination, uptake among adults with DM remains suboptimal. This study evaluates the effectiveness of interventions aimed at increasing Herpes Zoster (HZ) vaccine coverage in diabetic patients. Methods: This study included diabetic patients residing in the Romagna Local Health Authority (1.2 million inhabitants). Two complementary strategies were implemented: patient-oriented interventions (reminders/recalls) and provider-focused actions to engage general practitioners and diabetologists. Vaccination coverage in December 2023 was compared with December 2024, stratified by age, sex, and nationality. Primary outcomes were changes in coverage and intervention impact. Multivariate logistic regression assessed sociodemographic determinants of adherence. Results: As of 31 December 2023, 5182 diabetic patients had received at least one dose of Herpes Zoster vaccine (7.4% coverage). In 2024, overall coverage (11.1%) increased across all sociodemographic groups. Coverage rose to 12.8% in males and 9.0% in females and to 11.7% among Italian citizens, while foreign citizens showed lower absolute levels but a greater proportional increase. By age, individuals born after 1958 exhibited the largest relative growth, whereas those born in 1952–1958 reached the highest absolute coverage in 2024. Male sex, the 1952–1958 birth cohort, and Italian citizenship were associated with a higher likelihood of vaccination in both years. Conclusions: Our findings show a positive trend in Herpes Zoster vaccination among diabetic patients in Romagna HLA, driven by patient reminders, provider engagement, and age-targeted campaigns, while persistent sociodemographic disparities underscore the need for tailored strategies to optimize coverage.