Willingness to accept herpes zoster vaccines and the influencing factors in China

Evaluating the impact of the vaccination prescription program on herpes zoster vaccine coverage in Ningbo, China: An interrupted time series analysis

As the population ages, herpes zoster (HZ) and postherpetic neuralgia, which are associated with a substantial disease burden, are expected to increase. Ningbo began to implement the Vaccination Prescription Program for community individuals in April 2022. The anonymized HZ vaccination records of individuals aged above 50 during 2020-2023 were extracted from the Ningbo Immunization Information Management System. We applied interrupted time series analyses controlling for long-term trends and seasonality to assess the effects of the program on HZ vaccination coverage. Effect modification from demographic characteristics was investigated. Totally 18,133 doses of the HZ vaccine were administered. The cumulative coverage increased from 0.16‰ to 2.97‰, and the full series cumulative coverage from 0.04‰ to 2.48‰. Relatively higher coverage and full series coverage were observed among residents, females, individuals residing in inner districts and high socioeconomic regions, and those aged 50-59 years. During the transition period, a 468.7% increase in HZ vaccination coverage was evident (Rate Ratio [RR], 5.687; 95% Confidence Interval [CI], 2.334-13.857), and significant impact was detected among all demographic characteristics. During the post-implementation period, a 261.3% increase in coverage was evident (RR, 3.613; 95% CI, 1.202-10.858), while no effect was found among migrants, individuals living in regions with high socioeconomic status, and those aged above 70 years. Although the positive effect of the program, it is imperative to implement key strategies for providing affordable HZ vaccines, such as government funding, subsidies, and vaccination prescriptions from healthcare professionals, alongside peer initiatives and family members' education.

Patient preferences toward herpes zoster vaccination among individuals aged 50 years or older in South Korea: Findings from a discrete choice experiment

In South Korea, the increasing incidence of herpes zoster (HZ) and aging population warrant consideration of HZ vaccination for older adults. There is a need to understand the HZ vaccine-related preferences of adults aged ≥50 years and adult children (working or financially independent adults contributing to healthcare decision-making for their parents aged ≥50 years). A discrete choice experiment was conducted to elicit HZ vaccine preferences of the HZ-naïve general public aged ≥50 years (n = 500), current/former HZ patients aged ≥50 years (n = 150), and adult children (n = 150). An online questionnaire was administered through March-May 2023; for each preference-elicitation question, respondents selected between three hypothetical HZ vaccine profiles, characterized by five attributes with varying levels, or "no vaccine". Respondents generally accepted an increased number of doses (from one to two) for a longer protection duration (from ≥4 to ≥7 or ≥10 years). By mean relative importance (RI), protection duration (RI: 37.1%; 95% confidence interval [CI]: 36.0%, 38.1%), lifetime HZ risk reduction (27.3%; 95% CI: 26.3%, 28.4%) and short-term side effects (14.9%; 95% CI: 14.1%, 15.6%) had the strongest impact on respondents' HZ vaccine decision-making. Adult children viewed short-term side effects with significantly greater RI than the general public and current/former HZ patients (19.1%, 13.5%, 15.2%, respectively, p < .001). Respondents with selected comorbidities placed higher RI than those without comorbidities on protection duration (39.3% versus 34.2%, p < .001) and lower RI on prevention of HZ-related complications (8.7% versus 10.4%, p = .007). Findings may guide health policy design/refinement and physician-patient conversations on HZ vaccination/vaccines.

Herpes zoster vaccination coverage and factors associated among adults aged 40 and older in China: A population-based survey

OBJECTIVES

Herpes zoster (HZ) is a significant public health issue in China, especially with an aging population and rising incidence. While vaccination effectively prevents HZ and its complications, national data on HZ vaccine (HZV) coverage and associated factors in China are limited.

METHODS

We conducted a nationwide survey across 25 provinces in mainland China, including 14,315 participants aged over 40 years, to estimate HZV uptake and associated factors among adults aged 40 years and older. Multivariate logistic regression was used to assess characteristics linked to vaccination, and we analysed vaccine types and dose completion rates.

RESULTS

The HZV uptake rate was 0.79 %. Vaccination was more likely among individuals with middle school education and higher household income. Most vaccinated individuals received the zoster vaccine live (ZVL) rather than the recombinant zoster vaccine (RZV), and nearly half completed two doses.

CONCLUSIONS

HZV coverage in China is low, underscoring the need for targeted public health strategies to improve vaccine accessibility and awareness, particularly among at-risk groups, to reduce HZ-related burdens.

The barriers and facilitators of herpes zoster vaccination intentions of urban residents in China: a qualitative study

BACKGROUND

In an aging society, herpes zoster (HZ) increases the health burden on infected patients. While quantitative studies point to a lack of willingness to accept the HZ vaccine in China, there is limited number of studies with in-depth qualitative analysis on HZ vaccination intention. This study undertakes a qualitive study method to identify the barriers and facilitators behind urban residents' HZ vaccination intention in three China cities, and contributes towards some targeted vaccination promotion suggestions to China and other LMICs with similar low coverage of HZ vaccination.

METHODS

We conducted 12 focus group discussions in three cities of China. In each discussion we recruited 3 to 6 participants aged 20 and older to catch the views on the HZ vaccine from residents with a wider age range. Participants were recruited by purposive sampling techniques. Guided by the health belief model, thematic analysis was used to group participants' HZ vaccine attitudes and to identify the barriers and facilitators to HZ vaccination.

RESULTS

The attitude of 59 participants participating in the focus group discussions showed a low-level acceptability of the HZ vaccine with only 27.1% (16/59) displaying a willingness to HZ vaccine uptake. The barriers to HZ vaccination included limited or incorrect conception on HZ prevalence, risk factors, susceptibility, symptoms, prevention and treatment methods, and the high cost of the HZ vaccine. Perceived vulnerability to HZ, fear of HZ pain and individuals' financial capacity were the strongest facilitators to HZ vaccination. In addition, it was found that advocacy of HZ vaccination by health professionals or government financial subsidies to HZ vaccination, could attenuate the above barriers to HZ vaccine uptake.

CONCLUSIONS

Our study revealed a series of barriers and facilitators of HZ vaccination intention. We recommend HZ education and advocacy by health workers and government health officials to address the limited HZ knowledge and HZ misconceptions, and the government (or health insurance providers) to pay or subsidize the high costs of HZ vaccination to increase the HZ vaccination rate.

Unraveling Herpes Zoster Vaccine Hesitancy, Acceptance, and Its Predictors: Insights From a Scoping Review

Objectives

Herpes zoster vaccination is critical in preventing herpes zoster virus infection and its associated consequences. Despite its relevance, global herpes zoster immunisation coverage remains alarmingly low. Understanding the factors that drive vaccine scepticism and acceptance is crucial for increasing immunisation rates and improving public health outcomes.

Methods

This scoping review, following Joanna Briggs Institute guidelines, included 18 studies examining vaccine hesitancy, acceptance, and associated factors. Meticulous data analysis revealed hesitancy's intricate dynamics across countries and demographics.

Results

Studies displayed a wide range of acceptance rates (2.8%-89.02%), showcasing the complex interplay of attitudes and behaviors towards vaccination. Reasons for vaccine refusal were repeatedly identified in this setting, including worries about potential adverse effects, views of vaccine necessity, and vaccine supply constraints. Notably, individuals' patterns of vaccine acceptance and hesitancy differed among countries, vaccines, and vaccination-related factors.

Conclusion

Addressing acceptance hurdles by improving accessibility, providing accurate information, and strengthening healthcare recommendations is crucial. Understanding the multifaceted factors influencing hesitancy allows for targeted interventions, elevating immunization rates and enhancing public health globally.

Characteristics and economic burden of hospitalized patients with herpes zoster in China, before vaccination

Herpes zoster (HZ) brings a significant economic burden. The HZ vaccine was introduced in China for the first time in 2020, and there is a lack of up-to-date information on the hospitalization costs and characteristics prior to vaccination. This study aimed to describe the characteristics and economic burden of HZ inpatients in Hunan Province, China, and analyze the factors influencing the length of stay (LOS) and costs. This was a retrospective study and we extracted information from the Chinese National Health Statistics Network Reporting System on HZ inpatients in Hunan Province, China from 2017 to 2019. Spatial join tools and Global or Local Moran's Index were used for the geographic analysis of hospitalized HZ incidence. Multivariate linear regression models were used to analyze the factors influencing LOS and costs. There were 44,311 HZ inpatients included in this study, incurring a total of $31,857,734 medical costs. These patients had a median LOS of 8 days and a median expenditure of $573.47. Older age, more comorbidities, and the presence of complications with nervous system involved were all significantly associated with longer LOS and higher costs. HZ infection resulted in a large direct medical cost and heavy disease burden, especially in patients with advanced age or underlying medical conditions. The HZ vaccine has the potential to effectively reduce the disease burden and should be widely popularized especially among high-risk groups.

Willingness to vaccinate against herpes zoster in Chinese urban population: a mixed-methods study

OBJECTIVE

Although the herpes zoster vaccine has been available in mainland China since June 2020, residents' knowledge of herpes zoster and the herpes zoster vaccine is poor, and vaccination rates are low, especially among the elderly, who are at high risk for herpes zoster. This study assessed willingness to be vaccinated against herpes zoster and factors associated with vaccination among urban residents in China.

METHODS

A mixed-methods study was conducted in community health centres from August 2022 to September 2022. We used convenience sampling to select 2864 residents from 9 Chinese cities for the quantitative study and 67 adults for the qualitative study. A structured questionnaire was used for the quantitative study, and data were collected through face-to-face interviews. Multinomial logistic regression was used to analyse factors associated with willingness to vaccinate. Qualitative data were analysed using thematic analysis of barriers to herpes zoster vaccination.

RESULTS

A total of 2864 eligible respondents were included in the study. Of these, 42.67% intended to receive the herpes zoster vaccine, 21.44% refused and 35.89% were hesitant. The results of the quantitative and qualitative analyses showed that the factors associated with respondents' willingness to be vaccinated against herpes zoster included: personal characteristics such as gender, age and income; knowledge and attitudes about herpes zoster and the vaccine; vaccine characteristics such as efficacy, safety and price; and other factors such as pain tolerance and accessibility to vaccination.

CONCLUSION

The low willingness to vaccinate, especially among the elderly, is mainly related to their poor knowledge and negative attitude towards the infection and vaccination. Therefore, health education about herpes zoster, immunisation promotion, and improvement of accessibility and affordability would be valuable in China.

Willingness to receive Herpes Zoster vaccination among adults and older people: A cross sectional study in Italy

The objective of this study was to explore the Herpes Zoster (HZ) knowledge and the willingness to receive the HZ vaccination in adults and older people in Italy. The study was conducted on a sample of patients aged ≥65 years and over 50 years with chronic conditions who went to the clinics of general practitioners (GPs) in Campania region, Italy. Data was collected with a questionnaire administered through an interview. Multivariate logistic regression analysis was performed. 427 participants (83.2 %) had heard about HZ infection and correctly knew the main symptoms of the HZ disease, and 196 of them (45.9 %) were aware of the main complications of the infection, such as post-Herpetic Neuralgia (NPE) and Herpes Zoster ophthalmicus (HZO). Only 61 participants (11.8 %) had heard of the availability of a vaccination against HZ in Italy and 39 of them (63.9 %) knew that the vaccination is recommended in at-risk patients aged at least 50 years and for adults aged ≥65 years. 137 participants (26.6 %) had a positive attitude toward the willingness to receive the HZ vaccination. Participants aged 50-64 years, those who have more than one chronic disease, those who have received at least one recommended vaccination, those who had a positive attitude on the usefulness of HZ vaccination, and those who feel the need to receive additional information about HZ vaccination were more likely to have a positive attitude toward the willingness to receive the HZ vaccination. It is needed to implement effective strategies to improve HZ vaccination coverage in order to protect especially frail patients from the most serious complications of the disease.