{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T08:30:38Z","timestamp":1772613038265,"version":"3.50.1"},"reference-count":36,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"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\/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\u20131958 reached the highest absolute coverage in 2024. Male sex, the 1952\u20131958 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.<\/jats:p>","DOI":"10.3390\/vaccines14030209","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T14:51:29Z","timestamp":1772117489000},"page":"209","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["From Knowledge to Action: Enhancing Herpes Zoster Vaccine Uptake in Diabetic Patients Through Targeted Interventions"],"prefix":"10.3390","volume":"14","author":[{"given":"Marco","family":"Fabbri","sequence":"first","affiliation":[{"name":"Unit of Hygiene and Public Health Ravenna, Department of Public Health, Romagna Local Health Authority, 48121 Ravenna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6764-0187","authenticated-orcid":false,"given":"Giorgio","family":"Cavalli","sequence":"additional","affiliation":[{"name":"School of Hygiene and Preventive Medicine, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valeria","family":"Frassineti","sequence":"additional","affiliation":[{"name":"Unit of Hygiene and Public Health Ravenna, Department of Public Health, Romagna Local Health Authority, 48121 Ravenna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Di Bartolo","sequence":"additional","affiliation":[{"name":"Diabetes Clinic of Ravenna, Romagna Local Health Authority, University of Bologna, 48121 Ravenna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Reali","sequence":"additional","affiliation":[{"name":"Unit of Hygiene and Public Health Forl\u00ec-Cesena, Department of Public Health, Romagna Local Health Authority, 47522 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8813-792X","authenticated-orcid":false,"given":"Elizabeth","family":"Bakken","sequence":"additional","affiliation":[{"name":"Unit of Hygiene and Public Health Rimini, Department of Public Health, Romagna Local Health Authority, 47624 Rimini, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michela","family":"Morri","sequence":"additional","affiliation":[{"name":"Unit of Hygiene and Public Health Rimini, Department of Public Health, Romagna Local Health Authority, 47624 Rimini, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianluigi","family":"Belloli","sequence":"additional","affiliation":[{"name":"Unit of Hygiene and Public Health Forl\u00ec-Cesena, Department of Public Health, Romagna Local Health Authority, 47522 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianpiero","family":"Mancini","sequence":"additional","affiliation":[{"name":"Department of Public Health, Romagna Local Health Authority, 48121 Ravenna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3551-7486","authenticated-orcid":false,"given":"Manuela","family":"Chiavarini","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Florence, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Silvestrini","sequence":"additional","affiliation":[{"name":"Unit of Hygiene and Public Health Ravenna, Department of Public Health, Romagna Local Health Authority, 48121 Ravenna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1016\/S0264-410X(02)00623-0","article-title":"The Global Value of Vaccination","volume":"21","author":"Ehreth","year":"2003","journal-title":"Vaccine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1806","DOI":"10.1016\/j.mayocp.2017.10.009","article-title":"Risk Factors for Herpes Zoster: A Systematic Review and Meta-Analysis","volume":"92","author":"Kawai","year":"2017","journal-title":"Mayo Clin. Proc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1007\/s13300-018-0394-4","article-title":"Herpes Zoster and Diabetes Mellitus: A Review","volume":"9","author":"Papagianni","year":"2018","journal-title":"Diabetes Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2364","DOI":"10.1038\/s41598-023-29667-w","article-title":"Herpes Zoster and Long-Term Vascular Risk: A Retrospective Cohort Study","volume":"13","author":"Horev","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Marra, F., Ruckenstein, J., and Richardson, K. (2017). A Meta-Analysis of Stroke Risk Following Herpes Zoster Infection. BMC Infect. Dis., 17.","DOI":"10.1186\/s12879-017-2278-z"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1007\/s15010-014-0645-x","article-title":"Risk of Herpes Zoster among Diabetics: A Matched Cohort Study in a US Insurance Claim Database before Introduction of Vaccination, 1997\u20132006","volume":"42","author":"Guignard","year":"2014","journal-title":"Infection"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"111603","DOI":"10.1016\/j.diabres.2024.111603","article-title":"Hospitalisation for Herpes Zoster in People with and without Diabetes: A 10-Year-Observational Study","volume":"210","author":"Giorda","year":"2024","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1210\/clinem\/dgab675","article-title":"Association Between Diabetes Mellitus and the Risk of Herpes Zoster: A Systematic Review and Meta-Analysis","volume":"107","author":"Huang","year":"2022","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2366353","DOI":"10.1080\/21645515.2024.2366353","article-title":"The Public Health Impact of Recombinant Herpes Zoster Vaccination in Adults over 50 Years in Spain","volume":"20","year":"2024","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2606","DOI":"10.1080\/21645515.2017.1368600","article-title":"Risk and Impact of Herpes Zoster on Patients with Diabetes: A Population-Based Study, 2009\u20132014","volume":"13","year":"2017","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Immunization Agenda 2030 Partners (2024). Immunization Agenda 2030: A Global Strategy to Leave No One Behind. Vaccine, 42, S5\u2013S14.","DOI":"10.1016\/j.vaccine.2022.11.042"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Chiavarini, M., Bechini, A., Boccalini, S., Barash, A., Castellana, E., Senape, A., and Bonanni, P. (2025). Vaccination Against Herpes Zoster in Adults: Current Strategies in European Union Countries. Vaccines, 13.","DOI":"10.3390\/vaccines13101073"},{"key":"ref_13","unstructured":"(2026, February 20). Piano Nazionale di Prevenzione Vaccinale (PNPV) 2023\u20132025. Available online: https:\/\/www.epicentro.iss.it\/vaccini\/piano-nazionale-vaccini-2023-2025."},{"key":"ref_14","unstructured":"(2026, February 20). Normativa in Tema di Vaccinazioni. Available online: https:\/\/salute.regione.emilia-romagna.it\/sanita-pubblica\/vaccinazioni\/normativa-e-documentazione."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e1590","DOI":"10.1210\/clinem\/dgae476","article-title":"Vaccinome Landscape in Nearly 620 000 Patients with Diabetes","volume":"110","author":"Lazzaroni","year":"2025","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Salussolia, A., Capodici, A., Scognamiglio, F., La Fauci, G., Sold\u00e0, G., Montalti, M., Di Valerio, Z., Fantini, M.P., Odone, A., and Costantino, C. (2024). Herpes Zoster (HZ) Vaccine Coverage and Confidence in Italy: A Nationwide Cross-Sectional Study, the OBVIOUS Project. BMC Infect. Dis., 24.","DOI":"10.1186\/s12879-024-09344-7"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1038\/s41562-024-01940-6","article-title":"A Systematic Review and Meta-Analysis of Strategies to Promote Vaccination Uptake","volume":"8","author":"Liu","year":"2024","journal-title":"Nat. Hum. Behav."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Jacobson Vann, J.C., Jacobson, R.M., Coyne-Beasley, T., Asafu-Adjei, J.K., and Szilagyi, P.G. (2018). Patient Reminder and Recall Interventions to Improve Immunization Rates. Cochrane Database Syst. Rev., CD003941.","DOI":"10.1002\/14651858.CD003941.pub3"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.cmi.2016.11.007","article-title":"Addressing Vaccine Hesitancy: The Crucial Role of Healthcare Providers","volume":"23","year":"2017","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.vaccine.2022.10.063","article-title":"Safety and Efficacy of Recombinant and Live Herpes Zoster Vaccines for Prevention in At-Risk Adults with Chronic Diseases and Immunocompromising Conditions","volume":"41","author":"Sullivan","year":"2023","journal-title":"Vaccine"},{"key":"ref_21","unstructured":"Regione Emilia Romagna (2026, February 20). Le Principali Malattie Prevenibili con Vaccinazione: Herpes Zoster. Available online: https:\/\/salute.regione.emilia-romagna.it\/sanita-pubblica\/vaccinazioni\/le-principali-malattie-prevenibili-con-vaccinazione\/herpes-zoster."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1177\/08901171231200778","article-title":"A Scoping Review on Gender\/Sex Differences in COVID-19 Vaccine Intentions and Uptake in the United States","volume":"38","author":"Sileo","year":"2024","journal-title":"Am. J. Health Promot."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3975","DOI":"10.1080\/21645515.2021.1947098","article-title":"Gender Differences in the Determinants of Willingness to Get the COVID-19 Vaccine among the Working-Age Population in Japan","volume":"17","author":"Ishimaru","year":"2021","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1007\/s10389-021-01677-w","article-title":"Gender Differences in the Intention to Get Vaccinated against COVID-19: A Systematic Review and Meta-Analysis","volume":"31","author":"Zintel","year":"2023","journal-title":"J. Public Health"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Norhayati, M.N., Che Yusof, R., and Azman, Y.M. (2022). Systematic Review and Meta-Analysis of COVID-19 Vaccination Acceptance. Front. Med., 8.","DOI":"10.3389\/fmed.2021.783982"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Nehal, K.R., Steendam, L.M., Campos Ponce, M., Van Der Hoeven, M., and Smit, G.S.A. (2021). Worldwide Vaccination Willingness for COVID-19: A Systematic Review and Meta-Analysis. Vaccines, 9.","DOI":"10.3390\/vaccines9101071"},{"key":"ref_27","unstructured":"Jacqui, S., and Sagri, S. (2026, February 20). Addressing Gender-Related Barriers to COVID-19 Vaccinations to Ensure Vaccinations for All. United Nations University, UNU Centre, UNU-IIGH, 2022-04-28. Available online: https:\/\/unu.edu\/article\/addressing-gender-related-barriers-covid-19-vaccinations-ensure-vaccinations-all."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Mansilla, C., Kamlongera, A., and Dadari, I. (2025). Gender Barriers to Immunization: A Synthesis of UNICEF\u2019s Analyses to Advance Equity and Coverage. Vaccines, 13.","DOI":"10.3390\/vaccines13101059"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1080\/13548506.2023.2280462","article-title":"Gender and Vaccination: Understanding the Multifaceted Role of a Multidimensional Conceptualization of Vaccine Hesitancy","volume":"29","author":"Howard","year":"2024","journal-title":"Psychol. Health Med."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Ceccarelli, A., Scrimaglia, S., Fossi, V., Ceccaroni, L., Federici, A., Reali, C., Angelini, R., Silvestrini, G., Sintoni, F., and Fantini, M.P. (2022). Adherence to Herpes Zoster (Shingles) Catch-Up Campaign at the Romagna Local Health Authority (Italy), a Multi-Center Retrospective Observational Study. Vaccines, 10.","DOI":"10.3390\/vaccines10101770"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Jaca, A., Mathebula, L., Malinga, T., Rampersadh, K., Zulu, M., Hohlfeld, A.S.-J., Wiysonge, C.S., Jacobson Vann, J.C., and Ndwandwe, D. (2025). Interventions to Improve Vaccination Uptake Among Adults: A Systematic Review and Meta-Analysis. Vaccines, 13.","DOI":"10.20944\/preprints202505.1741.v1"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1093\/pubmed\/fdaf008","article-title":"Interventions in Primary Care to Increase Uptake of Adult Vaccines: A Systematic Review","volume":"47","author":"Wheeler","year":"2025","journal-title":"J. Public Health"},{"key":"ref_33","unstructured":"The Community Guide (2025, December 26). Vaccination: Provider Assessment\/Feedback. Available online: https:\/\/www.thecommunityguide.org\/findings\/vaccination-programs-provider-assessment-and-feedback.html."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Blanc-Rodriguez-Arias, J.M., Jimeno-Sanz, I., Hern\u00e1ndez-Barrera, V., \u00c1lvaro-Meca, A., Torres-Ramos, M., and Gil-de-Miguel, \u00c1. (2025). Demographic and Clinical Characteristics of Patients Vaccinated Against Herpes Zoster in a Primary Care Setting in Spain: A Retrospective Study. Vaccines, 13.","DOI":"10.3390\/vaccines13101069"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e102401","DOI":"10.1136\/bmjopen-2025-102401","article-title":"Real-World Data and Patient-Reported Outcomes in Diabetes in Emilia\u2013Romagna (REWINDER): Protocol of a Federated Cohort Study for the Regional Evaluation of Quality of Care during and after COVID-19","volume":"15","author":"Carinci","year":"2025","journal-title":"BMJ Open"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e45493","DOI":"10.2196\/45493","article-title":"Cost-Effectiveness Analyses of Digital Health Technology for Improving the Uptake of Vaccination Programs: Systematic Review","volume":"25","author":"Wang","year":"2023","journal-title":"J. Med. Internet Res."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/3\/209\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T05:19:14Z","timestamp":1772601554000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/3\/209"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,26]]},"references-count":36,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["vaccines14030209"],"URL":"https:\/\/doi.org\/10.3390\/vaccines14030209","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,26]]}}}