Attitude to Co-Administration of Influenza and COVID-19 Vaccines among Pregnant Women Exploring the Health Action Process Approach Model.

Respiratory tract diseases caused by influenza virus and SARS-CoV-2 can represent a serious threat to the health of pregnant women. Immunological remodulation for fetus tolerance and physiological changes in the gestational chamber expose both mother and child to fearful complications and a high risk of hospitalization. Vaccines to protect pregnant women from influenza and COVID-19 are strongly recommended and vaccine co-administration could be advantageous to increase coverage of both vaccines. The attitude to accept both vaccines is affected by several factors: social, cultural, and cognitive-behavioral. In Palermo, Italy, during the 2021-2022 influenza season, a cross-sectional study was conducted to evaluate pregnant women's intention to adhere to co-administration of influenza and COVID-19 vaccines. The determinants of vaccination attitude were investigated through the administration of a questionnaire and the Health Action Process Approach theory was adopted to explore the cognitive behavioral aspects. Overall, 120 pregnant women were enrolled; mean age 32 years, 98.2% (n = 118) of Italian nationality and 25.2% (n = 30) with obstetric or pathological conditions of pregnancy at risk. Factors significantly associated with the attitude to co-administration of influenza and COVID-19 vaccines among pregnant women were: high level of education (OR = 13.96; p < 0.001), positive outcome expectations (OR = 2.84; p < 0.001), and self-efficacy (OR = 3.1; p < 0.001). Effective strategies to promote the co-administration of the influenza vaccine and the COVID-19 vaccine should be based on the communication of the benefits and positive outcomes of vaccine co-administration and on the adequate information of pregnant women.

A 12-month follow-up of the immune response to SARS-CoV-2 primary vaccination: evidence from a real-world study.

A real-world population-based longitudinal study, aimed at determining the magnitude and duration of immunity induced by different types of vaccines against COVID-19, started in 2021 by enrolling a cohort of 2,497 individuals at time of their first vaccination. The study cohort included both healthy adults aged ≤65 years and elderly subjects aged >65 years with two or more co-morbidities. Here, patterns of anti-SARS-CoV-2 humoral and cell-mediated specific immune response, assessed on 1,182 remaining subjects, at 6 (T6) and 12 months (T12) after the first vaccine dose, are described. At T12 median anti-Spike IgG antibody levels were increased compared to T6. The determinants of increased anti-Spike IgG were the receipt of a third vaccine dose between T6 and T12 and being positive for anti-Nucleocapside IgG at T12, a marker of recent infection, while age had no significant effect. The capacity of T12 sera to neutralize in vitro the ancestral B strain and the Omicron BA.5 variant was assessed in a subgroup of vaccinated subjects. A correlation between anti-S IgG levels and sera neutralizing capacity was identified and higher neutralizing capacity was evident in healthy adults compared to frail elderly subjects and in those who were positive for anti-Nucleocapside IgG at T12. Remarkably, one third of T12 sera from anti-Nucleocapside IgG negative older individuals were unable to neutralize the BA.5 variant strain. Finally, the evaluation of T-cell mediated immunity showed that most analysed subjects, independently from age and comorbidity, displayed Spike-specific responses with a high degree of polyfunctionality, especially in the CD8 compartment. In conclusion, vaccinated subjects had high levels of circulating antibodies against SARS-CoV-2 Spike protein 12 months after the primary vaccination, which increased as compared to T6. The enhancing effect could be attributable to the administration of a third vaccine dose but also to the occurrence of breakthrough infection. Older individuals, especially those who were anti-Nucleocapside IgG negative, displayed an impaired capacity to neutralize the BA.5 variant strain. Spike specific T-cell responses, able to sustain immunity and maintain the ability to fight the infection, were present in most of older and younger subjects assayed at T12.

Impact of Actively Offering Influenza Vaccination to Frail People during Hospitalisation: A Pilot Study in Italy.

Despite the worldwide recommendations for influenza immunisation, vaccination coverage for patients exposed to the highest risk of severe complications is still far from the optimal target. The need to take advantage of alternative methods to provide vaccination is essential. This study presents a hospital-based strategy which offers influenza vaccination to inpatients at discharge. This study was conducted during the 2022-2023 influenza season at the University Hospital of Palermo. A questionnaire was administered to identify the determinants for the acceptance of influenza vaccination in the frail population. Overall, 248 hospitalised patients were enrolled, of which 56.1% were female and 52.0% were over 65 years of age. The proportion of patients vaccinated against influenza during hospitalisation was 62.5%, an increase of 16% in influenza vaccination uptake among frail people in comparison with the previous influenza season (46.8% vaccinated during the 2021-22 influenza season). Factors significantly associated with vaccination acceptance were the following: to have received influenza vaccine advice from hospital healthcare workers (OR = 3.57, p = 0.001), to have been previously vaccinated for influenza (OR = 3.16 p = 0.005), and to have had a low level of education (OR = 3.56, p = 0.014). This study showed that offering influenza vaccination to hospitalised patients could be an effective strategy to increase vaccination coverage in the most vulnerable population, and these findings could be useful for planning and improving future influenza vaccination campaigns.

Hepatitis a Vaccine as Opportunity of Primary Prevention for Food Handlers: A Narrative Review.

The hepatitis A virus (HAV) is still a leading cause of viral hepatitis worldwide. After a long incubation period, the clinical manifestations range from asymptomatic infection to acute liver failure. The severity of the disease increases with age and pre-existing liver disease. The transmission is mainly via person-to-person contact or ingestion of contaminated food or water. Food contamination can occur at any step of the food chain, especially when infected people handle not-heated or otherwise-treated food. HAV is endemic in low-income countries because of poor sanitary and sociodemographic conditions. The populations of developed countries are highly susceptible, and large outbreaks occur when HAV is introduced from endemic countries due to globalization, travel, and movement of foodstuffs. HAV prevention includes hygiene practices, immunoglobulins, and vaccination. Safe and effective inactivated and live attenuated vaccines are available and provide long-term protection. The vaccine targets are children and subjects at increased risk of HAV exposure or serious clinical outcomes. This review discusses the critical role of food handlers in the spread of HAV and the opportunity for food industry employers to consider food handler immunization a tool to manage both food safety in compliance with HACCP principles and food operators' biologic risk.

Measles Immunization Status of Health Care Workers: A Cross-Sectional Study Exploring Factors Associated with Lack of Immunization According to the Health Belief Model.

Suboptimal levels of measles vaccination coverage make Italy a country where the circulation of the virus is still endemic. In the past decade, several nosocomial outbreaks of measles occurred in Italy that rapidly spread the infection among large numbers of hospitalized patients and susceptible healthcare workers (HCWs). A cross-sectional study was conducted at the University Hospital of Palermo (Italy) to estimate the rate of HCWs immunization and to investigate the factors associated with lack of immunization. The attitude to the immunization practice was evaluated by exploring the Health Belief Model. Overall, 118 HCWs were enrolled, with a mean age of 31 years and 59.3% male. About half of the sample (45.8%, n = 54) was found not to be immunized against measles. Multivariable analysis showed that the factors directly associated with the non-immunization status against measles were female sex (OR = 3.70, p = 0.056), being an HCW different from a physician (OR = 10.27, p = 0.015), having a high perception of barriers to vaccination (OR = 5.13, p = 0.047), not being immunized for other exanthematous diseases such as chickenpox (OR = 9.93, p = 0.003), mumps (OR = 33.64, p < 0.001) and rubella (OR = 10.12, p= 0.002). There is a need to contrast the low adherence of HCWs to measles vaccination by identifying effective strategies to increase immunization coverage and limiting the risk of further nosocomial measles outbreaks.

Acceptability of HPV Vaccination in Young Students by Exploring Health Belief Model and Health Literacy.

Evidence on the human papillomavirus (HPV) vaccine shows that it is effective in reducing the burden of HPV-related diseases. For more than 15 years the HPV vaccine has been offered free of charge in Italy to girls from the age of 12. Over time, the free offer of the HPV vaccine has also been extended to boys and to young adults at risk of developing HPV lesions. Despite the HPV vaccine's effectiveness and availability, vaccination coverage is low in Italy, with a reported value of 46.5% in 2020. Furthermore, in the southern administrative regions, vaccination coverage is even lower than national values, with 25.9% coverage in Sicily. A cross-sectional study was conducted among university and high school students in the Palermo area (Sicily, Italy) in order to identify the determinants of HPV vaccination adherence by using a questionnaire that investigated factors of HPV vaccine practice. The study explored the behavioral attitude by using the Health Belief Model (HBM), and also used the SILS test and the METER test to investigate the level of health literacy (HL). Overall, 3,073 students were enrolled, and less than a third reported they had completed the vaccination schedule (n = 925, 30.1%). Multivariable analysis showed that the factors directly associated with the adherence to HPV vaccination were female sex (OR = 4.43, p < 0.001), high HBM total score (OR = 4.23, p < 0.001), good HL level (OR = 1.26, p = 0.047), parents (OR = 1.78, p = 0.004), general practitioner (OR = 1.88, p = 0.001), and educational material provided by public vaccination services (OR = 1.97, p = 0.001) as HPV vaccine information sources. Further health-promotion programs focused on improving HL and perception of the HPV vaccine's benefits should be implemented in order to achieve the desirable 95% vaccination coverage.

Clinical Severity in Different Waves of SARS-CoV-2 Infection in Sicily: A Model of Smith's "Law of Declining Virulence" from Real-World Data.

BACKGROUND: The COVID-19 epidemic had a rapid spread worldwide with a continuous and fast mutation of the virus, resulting in the emergence of several variants of concern (VOC). The aim of this study was to evaluate the severity of each VOC among SARS-CoV-2 infected subjects by investigating deaths, ICU admissions, intubations, and severe critical symptoms. METHODS: An ecological observational study was performed to evaluate mortality rates and clinical characteristics of 321,490 unvaccinated Sicilian SARS-CoV-2 cases observed from 2 March 2020 to 27 March 2022. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by multivariate logistic regression analysis evaluating factors determining a clinical worsening. RESULTS: Delta (adj-OR 3.00, 95% Cls 2.70-3.33) and wild-type (adj-OR 2.41, 95% Cls 2.2-2.62) variants had a higher risk than the Omicron strain for developing critical COVID-19 necessitating intubation and eventually undergoing death. Moreover, males appeared to be significantly more susceptible to developing the worst clinical outcome considered, as did older subjects. CONCLUSIONS: The present study provides evidence of factors implicated in the worsening of SARS-CoV-2-infection-related clinical outcomes. The study highlighted the different roles of VOC, in particular Delta and wild-type, and being male and elderly in the development of a worse clinical outcome.