Multidisciplinary model for administration of recombinant Zoster vaccine in fragile patients

BACKGROUND: Target populations eligible for vaccinations are not comprehensively reached by out-of-hospital health services, particularly frail people with immunization deficits. The aim of this study was to evaluate the effectiveness of a model of shared management between hospital - IRCCS Fondazione Policlinico Universitario A.Gemelli (FPG) - and out-of-hospital health services -ASL Roma1- of fragile patients with an indication for herpes zoster (HZ) vaccination, based on counseling carried out by a multidisciplinary team in the hospital setting. METHODS: From June 2022 to April 2023, patients with congenital and/or acquired immunodepression, who were treated at the IRCCS FPG in the Units of Hematology, Geriatrics, Infectious Diseases, Rheumatology were offered vaccination with the recombinant Zoster vaccine. At the time of enrollment, all patients completed the Vaccination Attitudes Examination (VAX-I) scale, for the purpose of assessing vaccine hesitancy. Patients received multidisciplinary counseling focusing on HZ and contrasting vaccine hesitancy. Multiple linear regression was used to analyze the impact of demographic and clinical characteristics on the VAX-I items. RESULTS: Sixty fragile patients were included. Mean vaccine hesitancy score was 2.1 ± 0.9. A significant correlation between vaccine hesitancy and the age group 45-64 years, female sex and patient with HIV was demonstrated. These patients had significantly higher score of “mistrust of vaccine benefits”, “worries about unforeseen future effects”, “concerns about commercial profiteering” and “preference for natural immunity”. After counseling, all patients adhered to the vaccination with two doses of a recombinant zoster vaccine. No serious adverse events or breakthrough HZ infections were observed during a median follow-up of 65.5 days. CONCLUSIONS: Although vaccine hesitancy in some age groups is high, hospital-based multidisciplinary counseling achieved full HZ vaccination compliance. KEY MESSAGES: • herpes zoster vaccination coverage of frail patients is not fully achieved in the community health setting. • The adoption of a multidisciplinary model for administration of recombinant Zoster vaccine in fragile patients based on a Hospital-Territory Vaccination Center may help overcome vaccine hesitancy.