Abstract
Adults with diabetes mellitus are at increased risk of vaccine-preventable infections and complications. Despite recommendations for adult immunization, uptake remains suboptimal in many low- and middle-income countries, including the Philippines, where data remain limited. This cross-sectional study assessed adult immunization coverage and associated clinical and sociodemographic factors among Filipino adults with diabetes recruited from inpatient, outpatient, and community outreach settings at a tertiary hospital. Uptake of influenza, pneumococcal, herpes zoster, hepatitis B, tetanus-diphtheria-pertussis (Td/Tdap), and COVID-19 vaccines was evaluated using prespecified operational definitions. Crude associations and parsimonious multivariable logistic regression models were examined; COVID-19 vaccination was not modeled because only six participants were unvaccinated. Among 284 participants (mean age 61.5 ± 12.7 y, 55.6% females), uptake was 44.4% for influenza, 49.6% for pneumococcal, 18.1% for herpes zoster, 15.5% for hepatitis B, 23.2% for Td/Tdap, and 97.9% for the primary COVID-19 series. Males had lower adjusted odds of influenza and pneumococcal vaccination, while increasing age was associated with pneumococcal uptake. Middle and high household income and diabetes duration of 5-10 y were associated with influenza vaccination. Among adults aged ≥50 y, male sex and high income were associated with herpes zoster vaccination. High income was also associated with hepatitis B and Td/Tdap uptake. Provider recommendation was associated with all outcomes, while lack of provider recommendation, failure to prioritize vaccination, and financial constraints were common reasons for non-vaccination. Uptake was uneven and low for most recommended adult vaccines. Integrating vaccine assessment and counseling into diabetes care while addressing financial and access barriers may improve uptake.