Influenza, pneumococcal, and herpes zoster vaccination in Italy: Knowledge, uptake, and determinants across the adult life course

Background: Vaccinations are fundamental to maintaining healthy aging, contributing to the prevention, reduction of complications, functional decline, and mortality associated with different infectious diseases. Vaccination coverage rates for influenza, herpes zoster, and pneumococcal infection exhibit significant heterogeneity and frequently show suboptimal levels. The aim of this study is to evaluate awareness and self-reported vaccination coverage for influenza, herpes zoster, and pneumococcal vaccines among an adult Italian population. Furthermore, the study aims to delineate specific patterns within this population. Methods: We analyzed data from the Look-Up 8+ project, which included adults aged 18 or more from various Italian regions. Participants completed a comprehensive lifestyle assessment and a structured interview regarding their influenza, pneumococcal, and herpes zoster vaccination habits. This included their level of awareness, whether they had received the vaccinations, and if not, the reasons behind their decision. Logistic regression models were used to examine the correlation between vaccination uptake and potential determinants. Results: Among 4575 participants (mean age 54.9 ± 16.0 years; 55% women), awareness of influenza vaccination was consistently high (>90%), whereas awareness of pneumococcal and herpes zoster vaccination was substantially lower and more heterogeneous. Influenza vaccination uptake increased with age (80% in women aged ≥80 years). Pneumococcal vaccination prevalence remained low in younger adults and increased after 70 years of age. Herpes zoster vaccination uptake was low overall. In multivariable analyses, increasing age was independently associated with uptake of influenza (OR 1.04; 95% CI 1.03-1.04), pneumococcal (OR 1.02; 95% CI 1.01-1.03), and herpes zoster vaccination. Smoking status, regular physical activity, and diabetes were positively associated with influenza and pneumococcal vaccination, while female sex and physical activity were associated with herpes zoster vaccination. Across all vaccines, the most frequently reported reason for non-vaccination was the perceived lack of necessity (45-59%), followed by lack of confidence in vaccines (13-18%) and fear of side effects (10%). Conclusions: Despite recommendations, awareness of and coverage for pneumococcal and herpes zoster vaccination remain low. More effective vaccination policies incorporating tailored educational strategies are needed.