Association between vaccination prescription program and herpes zoster vaccine knowledge, intention, and coverage among residents aged ≥50 in Zhejiang Province: Repeated cross-sectional surveys.

Abstract

The herpes zoster (HZ) vaccine has been available in China for a relatively short period, and vaccination coverage remains low. Zhejiang Province began to implement the vaccination prescription program in 35 counties from May 2024 under the background of integrated medical and preventive healthcare. This study aimed to evaluate the association between this program and changes in HZ vaccine knowledge, intention, and coverage among residents aged ≥50 y through repeated cross-sectional surveys. A multi-stage convenience sampling method was used to recruit participants before and after the intervention. Changes in all variables were assessed using chi-squared exact tests, while a Generalized Estimating Equations (GEE) model with binary logistic link and clustering by community health center was used to identify factors associated with vaccination. Following the program, significant improvements were observed across all HZ knowledge items, and vaccination coverage was 1.93% in the pre-implementation survey and 5.74% in the post-implementation survey. Notably, vaccination intention shifted toward hesitancy, with a decline in both positive and negative intent. In the adjusted GEE model, the survey period after program implementation was associated with higher odds of vaccination (AOR = 2.611, 95% CI: 1.895-3.597), and receiving a doctor's recommendation was associated with vaccination (AOR = 7.750, 95% CI: 5.747-10.451). The vaccination prescription program was associated with improved HZ vaccine knowledge, higher vaccination coverage, and increased rates of doctor's recommendation.