A survey about the degree of information and awareness of adolescents regarding vaccination in a Province of Central Italy.

Background: Understanding the level of awareness in adolescents on the value of vaccination is kay to developing a proper culture of prevention to counter vaccine hesitancy and the decrease in vaccination coverages. Study design: The aim of the survey was to evaluate awareness, attitudes, opinions, skills and knowledge about vaccines in a group of Italian adolescents through a paper-and-pencil questionnaire. Methods: The questionnaire was administered to adolescents who had appointments in two vaccination centers of the Public Health Authority of Latina (Latium, Italy), between August 2018 and January 2019. Results: In total, 391 forms were completed by teenagers (median age 16 years, 52% females), Results showed that 53% of participants were not aware of their vaccination status. Knowledge, assessed through questions about vaccines and preventable diseases, was generally poor. However, 89% of adolescents had a positive opinion about vaccinations. Spontaneous searches for vaccine information was low (28.7% had looked for information), despite the medium to high interest expressed. The participants usually sought information on vaccines on generic websites (52.8%) compared to getting information from paediatricians (20.4%) or other physicians (3.7%). However, participants recognized paediatricians/GPs (47%) and schools (46.2%) as the most reliable sources of information. Conclusions: Findings are in agreement with previous published data and can be useful to school and health educators in order to teach adolescents about the value of prevention, providing them with the support necessary to improve their abilities and knowledge.

Validation of an Italian tool to assess vaccine literacy in adulthood vaccination: a pilot study.

Vaccine Literacy (VL) is based on the same idea of Health Literacy (HL): it involves people's knowledge, motivation and competence to find, understand and use information to take decisions about children's and adults' vaccination. Using general measures, the association between HL and Vaccine Hesitancy has been shown to be inconsistent. HLVa-IT is a new tool, specific for the self-assessment of three VL scales, functional, interactive and critical about adults' immunization. Following a face validation process, HLVa-IT has been used to assess VL levels in a population of 50-75 years of age at the Public Health Unit of Latina (Latium, Italy). In order to validate its theoretical construct, it was administered at the same time with a Vaccine Quiz (VQ), assuming that subjects showing good knowledge about vaccination should have adequate VL. The consistent positive correlation for all three VL scales with the VQ score (Spearman's r=0.320, P=0.0004; r=0.389. P=0.0001 and r=0.306, P=0.0022, respectively), as well as with the educational degree, confirm the valid construct of HLVa-IT. A criterion validity of this tool has also been sought verifying its relation with acceptance of vaccines (VA) recommended in the adult/senior age. A positive association with VA observed only on the functional scale in the population ≥ 65 years, does not permit to accept a predictive validity, confirming that direct effect of Health Literacy is more clearly verifiable on knowledge than behavior outcomes. Nevertheless, HLVa-IT has shown suitable psychometric characteristics for the subjective measure of VL in individuals and in population studies. It is desirable that more specific tools are validated and extensively used, with the aim of assessing peoples' VL skills and defining interventions aimed at their improvement.

Attributable mortality of carbapenem-resistant Klebsiella pneumoniae infections in a prospective matched cohort study in Italy, 2012-2013.

BACKGROUND: In Italy, infections with carbapenem-resistant Klebsiella pneumoniae (CRKP) have increased markedly since 2009, creating unprecedented problems in healthcare settings and limiting treatment options for infected patients. AIM: To assess the attributable mortality due to CRKP in ten Italian hospitals and to describe the clinical characteristics of patients with an invasive CRKP and carbapenem-susceptible K. pneumoniae (CSKP) infection. METHODS: We conducted a matched cohort study, and calculated crude and attributable mortality for CRKP. The attributable mortality was calculated by subtracting the crude mortality rate of the patients with CSKP from the crude mortality rate of the patients with CRKP. We also described the clinical characteristics of CRKP and CSKP patients and analysed the determinants of mortality by using conditional Poisson regression. FINDINGS: The study included 98 patients, 49 with CRKP and 49 with CSKP. CRKP patients had undergone more invasive procedures and also tended to have more serious conditions, measured by higher Simplified Acute Physiology Score II. The attributable mortality of CRKP at 30 days was 41%. CRKP patients were three times more likely to die within 30 days [matched incidence rate ratio (mIRR): 3.0; 95% confidence interval (CI): 1.5-6.1]. Adjusting for potential confounders, the risk remained the same (adjusted mIRR: 3.0; 95% CI: 1.3-7.1). CONCLUSION: CRKP infection had a marked effect on patient mortality, even after adjusting for other patient characteristics. To control the spread of CRKP we recommend prioritization of control measures in hospitals where CRKP is found.

Surveillance of congenital rubella and rubella infections in pregnancy in EU/EEA countries, 2012: Current status and future perspective to monitor elimination.

INTRODUCTION: Rubella elimination and congenital rubella syndrome (CRS) prevention are targets for achievement by 2015 in the WHO-EURO Region. This paper describes the existing surveillance systems for CRS and rubella in pregnancy in order to critically interpret the findings in relation to the 2012 WHO-EURO surveillance guidelines. METHODS: In 2012 we conducted a survey to collect information on surveillance of CRS and rubella in pregnancy in 29 EU/EEA countries. Questionnaires explored the characteristics of the surveillance systems, case definition, epidemiological investigation and follow-up of cases, reference laboratories and types of tests performed. RESULTS: Twenty-eight countries had surveillance systems for CRS, mostly nationwide, mandatory, passive and case-based; 23 collected information on the origin of the infection; 11 reported asymptomatic infections; 6 required zero-reporting. Case definitions varied among countries, although 24 used the EU definition. Laboratories reported cases in 18 countries. Twenty countries collected information on pregnancy within the rubella surveillance system and 5 had specific surveillance for rubella in pregnancy. Two countries did not monitor outcomes of suspected infections in pregnancy; infants with CRS were monitored in all the remaining countries; asymptomatic infected infants in 15; stillbirths and fetal deaths in 13; therapeutic and spontaneous abortions in 8 and 7. Twenty-seven countries had a national reference laboratory for CRS and rubella in pregnancy; genotyping was performed in 15. DISCUSSION: The current surveillance systems allow adequate CRS monitoring in EU. Further efforts are needed to improve their quality, including uniform case definitions, collection of information on the origin of infection, and promotion of reporting from laboratories. Follow-up of pregnant women with suspected infection should be strengthened because it is an entry point for CRS, including detection of fetal deaths, stillbirths and abortions. Laboratory capacity for confirming congenital rubella infections and infections in pregnancy is good in EU, however the use of genotyping should be encouraged.

Congenital rubella still a public health problem in Italy: analysis of national surveillance data from 2005 to 2013.

In accordance with the goal of the World Health Organization Regional Office for Europe, the Italian national measles and rubella elimination plan aims to reduce the incidence of congenital rubella cases to less than one case per 100,000 live births by the end of 2015. We report national surveillance data for congenital rubella and rubella in pregnancy from 2005 to 2013. A total of 75 congenital rubella infections were reported; the national annual mean incidence was 1.5/100,000 live births, including probable and confirmed cases according to European Union case definition. Two peaks occurred in 2008 and 2012 (5.0 and 3.6/100,000 respectively). Overall, 160 rubella infections in pregnancy were reported; 69/148 women were multiparous and 38/126 had had a rubella antibody test before pregnancy. Among reported cases, there were 62 infected newborns, 31 voluntary abortions, one stillbirth and one spontaneous abortion. A total of 24 newborns were unclassified and 14 women were lost to follow-up, so underestimation is likely. To improve follow-up of cases, systematic procedures for monitoring infected mothers and children were introduced in 2013. To prevent congenital rubella, antibody screening before pregnancy and vaccination of susceptible women, including post-partum and post-abortum vaccination, should be promoted. Population coverage of two doses of measles-mumps-rubella vaccination of ≥ 95% should be maintained and knowledge of health professionals improved.

Seasonal influenza immunisation in Europe. Overview of recommendations and vaccination coverage for three seasons: pre-pandemic (2008/09), pandemic (2009/10) and post-pandemic (2010/11).

Since 2008, annual surveys of influenza vaccination policies, practices and coverage have been undertaken in 29 European Union (EU)/ European Economic Area (EEA) countries. After 2009, this monitored the impact of European Council recommendation to increase vaccination coverage to 75% among risk groups. This paper summarises the results of three seasonal influenza seasons: 2008/09, 2009/10 and 2010/11. In 2008/09, 27/29 countries completed the survey; in 2009/10 and 2010/11, 28/29 completed it. All or almost all countries recommended vaccination of older people (defined as those aged ≥50, ≥55, ≥59, ≥60 or ≥65 years), and people aged ≥6 months with clinical risk and healthcare workers. A total of 23 countries provided vaccination coverage data for older people, but only 7 and 10 had data for the clinical risk groups and healthcare workers, respectively. The number of countries recommending vaccination for some or all pregnant women increased from 10 in 2008/09 to 22 in 2010/11. Only three countries could report coverage among pregnant women. Seasonal influenza vaccination coverage during and after the pandemic season in older people and clinical groups remained unchanged in countries with higher coverage. However, small decreases were seen in most countries during this period. The results of the surveys indicate that most EU/EEA countries recommend influenza vaccination for the main target groups; however, only a few countries have achieved the target of 75% coverage among risk groups. Coverage among healthcare workers remained low.

Mandatory and recommended vaccination in the EU, Iceland and Norway: results of the VENICE 2010 survey on the ways of implementing national vaccination programmes.

This report provides an updated overview of recommended and mandatory vaccinations in the European Union (EU), Iceland and Norway, considering the differences in vaccine programme implementation between countries. In 2010, the Vaccine European New Integrated Collaboration Effort (VENICE) network, conducted a survey among the VENICE project gatekeepers to learn more about how national vaccination programmes are implemented, whether recommended or mandatory. Information was collected from all 27 EU Member States, Iceland and Norway. In total 15 countries do not have any mandatory vaccinations; the remaining 14 have at least one mandatory vaccination included in their programme. Vaccination against polio is mandatory for both children and adults in 12 countries; diphtheria and tetanus vaccination in 11 countries and hepatitis B vaccination in 10 countries. For eight of the 15 vaccines considered, some countries have a mixed strategy of recommended and mandatory vaccinations. Mandatory vaccination may be considered as a way of improving compliance to vaccination programmes. However, compliance with many programmes in Europe is high, using only recommendations. More information about the diversity in vaccine offer at European level may help countries to adapt vaccination strategies based on the experience of other countries. However, any proposal on vaccine strategies should be developed taking into consideration the local context habits.

Immunisation registers in Italy: a patchwork of computerisation.

In Italy, the 21 regional health authorities are in charge of organising and implementing their own vaccination strategy, based on the national vaccine plan. Immunisation coverage varies greatly among the regions for certain vaccines. Efforts to increase childhood immunisation coverage have included initiatives to develop and implement computerised immunisation registers in as many regions as possible. We undertook a cross-sectional online survey in July 2011 to provide an updated picture of the use, heterogeneity and main functions of different computerised immunisation registers used in the Italian regions and to understand the flow of information from local health units to the regional authorities and to the Ministry of Health. Comparing current data with those obtained in 2007, a substantial improvement is evident. A total of 15 regions are fully computerised (previously nine), with 83% of local health units equipped with a computerised register (previously 70%). Eight of the 15 fully computerised regions use the same software, simplifying data sharing. Only four regions are able to obtain data in real time from local health units. Despite the progress made, the capacity to monitor vaccination coverage and to exchange data appears still limited.

Influenza A(H1N1)pdm09 vaccination policies and coverage in Europe.

In August 2010 the Vaccine European New Integrated Collaboration Effort (VENICE) project conducted a survey to collect information on influenza A(H1N1)pdm09 vaccination policies and vaccination coverage in the European Union (EU), Norway and Iceland. Of 29 responding countries, 26 organised national pandemic influenza vaccination and one country had recommendations for vaccination but did not have a specific programme. Of the 27 countries with vaccine recommendations, all recommended it for healthcare workers and pregnant women. Twelve countries recommended vaccine for all ages. Six and three countries had recommendations for specific age groups in children and in adults, countries for specific adult age groups. Most countries recommended vaccine for those in new risk groups identified early in the pandemic such as morbid obese and people with neurologic diseases. Two thirds of countries started their vaccination campaigns within a four week period after week 40/2009. The reported vaccination coverage varied between countries from 0.4% to 59% for the entire population (22 countries); 3% to 68% for healthcare workers (13 countries); 0% to 58% for pregnant women (12 countries); 0.2% to 74% for children (12 countries). Most countries identified similar target groups for pandemic vaccine, but substantial variability in vaccination coverage was seen. The recommendations were in accordance with policy advice from the EU Health Security Committee and the World Health Organization.

The current state of introduction of human papillomavirus vaccination into national immunisation schedules in Europe: first results of the VENICE2 2010 survey.

The Venice 2 human papillomavirus vaccination survey evaluates the state of introduction of the HPV vaccination into the national immunisation schedules in the 29 participating countries. As of July 2010, 18 countries have integrated this vaccination. The vaccination policy and achievements vary among those countries regarding target age groups, delivery infrastructures and vaccination coverage reached. Financial constraints remain the major obstacle for the 11 countries who have not yet introduced the vaccination.

Differences in national influenza vaccination policies across the European Union, Norway and Iceland 2008-2009.

In 2009 the second cross-sectional web-based survey was undertaken by the Vaccine European New Integrated Collaboration Effort (VENICE) project across 27 European Union (EU) member states (MS), Norway and Iceland (n=29) to determine changes in official national seasonal influenza vaccination policies since a survey undertaken in 2008 and to compare the estimates of vaccination coverage between countries using data obtained from both surveys. Of 27 responding countries, all recommended vaccination against seasonal influenza to the older adult population. Six countries recommended vaccination of children aged between six months and <18 years old. Most countries recommended influenza vaccination for those individuals with chronic medical conditions. Recommendations for vaccination of healthcare workers (HCW) in various settings existed in most, but not all countries. Staff in hospitals and long-term care facilities were recommended vaccination in 23 countries, and staff in out-patient clinics in 22 countries. In the 2009 survey, the reported national estimates on vaccine coverage varied by country and risk group, ranging from 1.1% - 82.6% for the older adult population; to between 32.9% -71.7% for clinical risk groups; and from 13.4% -89.4% for HCW. Many countries that recommend the influenza vaccination do not monitor the coverage in risk groups. In 2008 and 2009 most countries recommended influenza vaccination for the main risk groups. However, despite general consensus and recommendations for vaccination of high risk groups, many countries do not achieve high coverage in these groups. The reported vaccination coverage still needs to be improved in order to achieve EU and World Health Organization goals.

[Rubella epidemiology in Italy in years 1998-2004]. / Epidemiologia della rosolia in Italia negli anni 1998-2004.

In November 2003 the National Plan for the elimination of measles and congenital rubella was approved, with the aim of reducing and maintaining the incidence of congenital rubella syndrome (CRS) at less than 1 case per 100,000 live births by 2007. In order to describe the epidemiology of rubella in Italy, we conducted a serosurvey and evaluated incidence and vaccination coverage data available for the period 1998-2004. In the years considered, national mean coverage of measles-mumps-rubella vaccination within the second year of life, even though still below the 95% threshold, has progressively increased reaching 87%. In addition, previously existing differences in coverage among regions have diminished. In the same period the incidence of rubella has decreased, with a historic minimum of 461 cases notified in 2004. The cyclic pattern typical of rubella persists, but with a prolongation of the interepidemic period and an increased mean age of acquisition of the infection. Although the proportion of immune individuals has increased, the percentage of women of childbearing age susceptible to rubella remains high (11% in the 15-19 year age group and 8% in the 20-39 year age group) and CRS cases continue to occur. Despite the clear results achieved through the implementation of vaccination strategies in children within the second year of life, a continued strong public health commitment is required to increase the proportion of vaccinated individuals and absolute priority must be given to immunising women of childbearing age.

Rubella seroprofile of the Italian population: an 8-year comparison.

The objective of this study is to evaluate how increasing MMR infant vaccination coverage in recent years has modified the epidemiology of rubella in Italy. A cross-sectional population-based seroprevalence study of rubella antibodies was conducted on 3094 sera, in 2004, and results were compared with data obtained by the same method in 1996. The overall proportion of rubella-seropositive individuals was found to be significantly higher in 2004 with respect to 1996 (84.6% vs. 77.4%). However, an increase in seropositivity was observed only in the 1-19 years age groups. Recent increases in childhood MMR vaccination coverage, therefore, have not had an impact on seroprevalence in women of childbearing age, over 5% of whom remain susceptible to rubella. Preconception screening and postpartum vaccination of susceptible women are fundamental if the WHO target of less than one case of congenital rubella syndrome per 100,000 live births is to be attained.

[Growth disorders in Down's syndrome: growth hormone treatment]. / Disturbo della crescita nella sindrome de Down: terapia con ormone della crescita.

BACKGROUND: The aim of the study was evaluate the short and long-term effects of growth hormone therapy in subjects affected by Trisomy 21. METHODS: The growth curves of 10 Down's syndrome patients (3 males and 7 females) aged between 21 and 35 years old were analysed. During pre- or peripuberty these subjects had received growth hormone (GH) therapy lasting an average of 3.02 years. At distance of between 10 to 15 years after the end of GH therapy, routine laboratory tests (thyroid hormones, glycemia, glycosylated hemoglobin, transaminase) were carried out together with a full hematological assay (hemochrome using leukocyte formula, morphological study of blood components). RESULTS: GH therapy resulted in an increased rate of growth among these subjects and a improvement in final stature of 5.16 cm in males and 7.35 cm in females. The long-term controls did not reveal any hematological changes or changes in HbA1c concentrations, thyroid function and hepatic function, thus confirming the absence of collateral effects of GH therapy in subjects with Down's Syndrome. CONCLUSIONS: In view of these results, we are convinced that GH therapy is extremely positive in trisomy 21, given the marked improvements in terms of growth, the absence of collateral effects and the possible psychological benefits of increased stature, in particular a better insertion in society.