Safety profile of recombinant adjuvanted anti-herpes zoster vaccine (RZV) in high-risk groups: Data from active surveillance program. Puglia (Italy), 2021-23.

BACKGROUND: Since 2021 a recombinant adjuvanted anti-Herpes Zoster vaccine(Recombinant Zoster Vaccine, RZV) is offered in Italy to high-risk patients. Few real-life data about RZV safety are available in target populations. OBJECTIVES: This study investigates Adverse Events Following Immunization(AEFIs), baseline disease flare-ups, and Herpes Zoster (HZ) episodes occurring after RZV administration in a heterogeneous population of fragile patients to design its safety profile. METHODS: This is a retrospective population-based study. RZV-vaccinated patients at Bari Policlinico General Hospital vaccination clinic from October 1st, 2021, to March 31st, 2023, were enrolled. Subjects were screened for reason of RZV eligibility and baseline chronic pathologies. AEFIs occurred in the first 7-days post-vaccination period were collected, and baseline disease flare-ups and post-vaccination HZ episodes were assessed via a 3-month follow-up. RESULTS: Five-hundred-thirty-eight patients were included and total of 1,031 doses were administered. Most patients were vaccinated due to ongoing immunosuppressive therapy(54.65 %); onco-hematological and cardiovascular conditions were the most common chronic baseline pathologies. Out of 1,031 follow-ups, 441 AEFI cases were reported(42.7/100). The most common symptoms were injection site pain/itching(35.60/100), asthenia/malaise(11.44/100), and fever (10.09/100). Four serious AEFIs occurred(0.38/100). Older age, male sex, and history of cardiovascular diseases(OR:0.71; 95CI:0.52-0.98; p-value <0.05) were found to decrease AEFIs risk, while endocrine-metabolic illnesses(OR:1.61; 95CI:1.15-2.26; p-value <0.05) increased it. Twelve patients(2.23 %) reported a flare-up/worsening of their baseline chronic condition within the first three months after vaccination(mean interval 31.75 days, range 0-68 days). Patients with rheumatological illnesses had a higher risk of relapse(OR:16.56; 95CI:3.58-76.56; p-value <0.001), while male sex behaved as a protective factor. Twelve patients who completed the vaccination cycle(2.43%) had at least one HZ episode by the long-term follow-up. CONCLUSIONS: The study demonstrates RZV safety in a significant number of high-risk patients. Hence, RZV should be actively offered as part of tailored vaccination programs to decrease the burden of HZ in fragile populations.

A snapshot of Physical Education in Italian primary schools: assessing the resources available for an instrument of health promotion.

Background: Regular physical activity is crucial in preventing chronic diseases. International health authorities recommend that children and adolescents engage in at least 60 minutes of moderate to vigorous physical activity per day to achieve health benefits. Offering regular exercise opportunities to young people can promote the development of healthy lifestyles. In 2021, a new regulation introduced up to two compulsory hours of Physical Education per week in Italy and established that Physical Education should be entrusted to adequately trained teachers. The present study aimed to assess, from the perspective of the new teachers, the resources available for Physical Education in Italian primary schools. Methods: A questionnaire-based cross-sectional study was conducted among primary school Physical Education teachers during the year 2022-2023. Their opinion about the school resources were analyzed in light of their demographic characteristics and work experience. Results: Out of the 118 participating teachers, 96 (81.3%) reported the presence of a gym in their school. Participants expressed satisfaction with the size and windows of the gym, particularly for the schools of the North, as well as the adequacy of outdoor spaces. However, lower levels of satisfaction for locker rooms and gym small equipment emerged, especially among those teachers with less work experience. Conclusions: The introduction of the Physical Education teacher figure in Italian primary schools was an important step for health promotion in our country. However, some aspects related to the structural resources should be considered in future policies.

Genotypic and phenotypic characteristics of Candida parapsilosis bloodstream isolates: Health Care Associated Infections in a teaching Hospital in Italy.

BACKGROUND: Candidemia is the most common healthcare associated invasive fungal infection. Over the last few decades, candidemia caused by Candida species other than Candida albicans, particularly the Candida parapsilosis complex, has emerged worldwide. The aims of this study were: to analyze the genotypic and phenotypic characteristics of C. parapsilosis strains isolated from blood cultures and the environment in a hospital in southern Italy, to study the possible source of infection and to correlate the isolated strains. METHODS: From April to October 2022, cases of candidemia due to C. parapsilosis in patients admitted to a hospital in the Apulia region were investigated. However, 119 environmental samples from the intensive care unit were collected for identification of the likely environmental reservoir of infection. Routine antifungal (amphotericin B, anidulafungin, fluconazole) susceptibility was performed on all isolates. Whole genome sequencing was performed to study the genotypic correlation of the isolates. Biofilm biomass and metabolic activity were also quantified for all isolates. RESULTS: A total of 43 C. parapsilosis isolates were cultured from the bloodstream of each patient in different departments, and seven surface samples were positive for C. parapsilosis. Most of the isolated yeasts (41/50; 85 %) were resistant to fluconazole and were genetically related to each other, suggesting an ongoing clonal outbreak of this pathogen. The fluconazole-susceptible isolates produced significantly more biofilm than did the resistant isolates. Metabolic activity was also higher for fluconazole-susceptible than resistant isolates. CONCLUSION: Cross-transmission of the microorganisms is suggested by the phenotypic similarity and genetic correlation between clinical and environmental strains observed in our study.

Assessing the temporal and cause-effect relationship between myocarditis and mRNA COVID-19 vaccines. A retrospective observational study.

OBJECTIVE: In 2021, the US Centers for Disease Control and Prevention reported increased cases of myocarditis and pericarditis in the United States after mRNA COVID-19 vaccines. Our study aims to estimate the incidence of myocarditis in Apulia (Southern Italy) and the cause-effect relationship between COVID-19 mRNA vaccines and the risk of myocarditis. METHODS: The Apulian regional archive of hospital discharge forms was used to define the cases of myocarditis in Apulia, considering data from 2017 to 2022. The overall vaccination status of patients was assessed via data collected from the Regional Immunization Database. The history of SARS-CoV-2 infection was extracted from the Italian Institute of Health platform. RESULTS: Since 2017, 5687 cases of myocarditis have been recorded in Apulian subjects; the overall incidence described a decreasing trend, with a slight increase in 0-40 years-old subjects. From 2021 to 2022, 2,930,276 doses of COVID-19 mRNA vaccines were administered; a diagnosis of myocarditis after the second dose of the mRNA vaccine was reported for 894 (0.03%) of Apulian inhabitants, with an incidence rate of 17.9 × 1,000,000 persons-month. The multivariate analysis, adjusted for age, sex, underlying medical conditions, and diagnosis of COVID-19, showed that mRNA vaccination is a protective factor for myocarditis even in younger subjects (aOR = 0.4; 95% CI = 0.3-0.5). CONCLUSION: A temporal association between an exposure and an outcome is not equivalent to a causal association. Our study underlines how an approach that considers the other potential causes of myocarditis (primarily COVID-19) and a causality assessment must be prioritized in the study of the topic.

The community nurse's role on the promotion of papillomavirus vaccination among young students: A study protocol.

Vaccination is the principal strategy for primary prevention of infection by Human Papilloma Virus (HPV), which causes different pathological conditions, up to cancer, in both males and females. However, to date, knowledge among adolescents and their parents about the HPV vaccine is still low. The aim of this quasi-experimental, multicenter study is to assess the effectiveness of a digital educational intervention, conducted by a multidisciplinary health-care team including a Community Nurse, to increase adolescents' HPV vaccination uptake, their knowledge, self-efficacy, feelings and involvement in HPV vaccine decision-making, and parents' vaccination hesitancy. The study will be carried out among a population of students (and their parents), aged between 11 and 13, at secondary schools in Italy. Validated questionnaires will be administered to both students and parents at baseline (T0) and 3 months after a digital educational intervention (T1). The findings may be useful in evaluating and deepening a methodology for designing and implementing educational interventions, embedded in the school setting, that could promote the achievement of outcomes within the broader process of youth's health promotion.

SARS-CoV-2 Infections, Re-Infections and Clinical Characteristics: A Two-Year Retrospective Study in a Large University Hospital Cohort of Vaccinated Healthcare Workers.

At the University Hospital of Bari, during the first year after the start of the mandatory vaccination campaign with BNT162b2 mRNA COVID-19 vaccine, the preliminary results of an observational study showed a significant prevalence of SARS-CoV-2 breakthrough infections (BIs) among healthcare workers (HCWs), but no hospitalization or deaths. In the present study, we extended the observation period (January 2021-January 2023) with the aim of determining the incidence, characteristics and clinical course of SARS-CoV-2 BIs among 6213 HCWs. All HCWs were regularly monitored and screened. To allow return to work after BI, the protocol required one negative nasopharyngeal swab test followed by a medical examination certifying complete clinical recovery. We observed an overall incidence rate of SARS-CoV-2 BIs of 20.2%. Females were most affected, especially in the nurse group compared with doctors and other HCWs (p < 0.0001). Cardiovascular diseases were the most frequent comorbidity (n = 140; 11.4%). The source of infection was non-occupational in 52.4% of cases. Most cases (96.9%) showed minor symptoms and only two cases of hospitalization (one in intensive care unit), 13 cases of re-infection and no deaths were recorded. Our results confirm that SARS-CoV-2 infection can break vaccination protection but the clinical course is favorable.

COVID-19 Vaccine Knowledge, Attitude, Acceptance and Hesitancy among Pregnancy and Breastfeeding: Systematic Review of Hospital-Based Studies.

The risk of unfavourable outcomes for SARS-CoV-2 infection is significant during pregnancy and breastfeeding. Vaccination is a safe and effective measure to lower this risk. This study aims at reviewing the literature concerning the anti-SARS-CoV-2 vaccine's acceptance/hesitancy among pregnant and breastfeeding women attending hospital facilities. A systematic review of literature was carried out. Hospital-based observational studies related to vaccination acceptance, hesitancy, knowledge and attitude among pregnant and breastfeeding women were included. Determinants of acceptance and hesitancy were investigated in detail. Quality assessment was done via the Johann Briggs Institute quality assessment tools. After literature search, 43 studies were included, 30 of which only focused on pregnant women (total sample 25,862 subjects). Sample size ranged from 109 to 7017 people. Acceptance of the SARS-CoV-2 vaccine ranged from 16% to 78.52%; vaccine hesitancy ranged between 91.4% and 24.5%. Fear of adverse events for either the woman, the child, or both, was the main driver for hesitancy. Other determinants of hesitancy included religious concerns, socioeconomic factors, inadequate information regarding the vaccine and lack of trust towards institutions. SARS-CoV-2 vaccine hesitancy in hospitalized pregnant women appears to be significant, and efforts for a more effective communication to these subjects are required.

Attitudes toward influenza vaccination in healthcare workers in Italy: A systematic review and meta-analysis.

Healthcare workers (HCWs) are among the at-risk groups for whom influenza vaccination is strongly recommended. To assess the proportion of Italian HCWs with positive attitudes toward influenza vaccination, we conducted a systematic review of relevant literature and a meta-analysis. Our focus was on the influenza seasons from 2017/18 to 2021/22. The prevalence of favorable attitudes toward vaccination varied, ranging from 12% during the 2017/18 influenza season to 59% in the 2020/21 season. The significant increase in the 2020/21 season can be attributed to adaptations necessitated by the COVID-19 pandemic. During the 2021/22 influenza season, there was a decline in vaccination coverage (37%), likely due to the absence of a robust preventive culture. Various strategies have been employed to enhance HCWs' attitudes to achieve higher vaccination rates, but none of them have demonstrated satisfactory results. Policymakers should consider implementing a policy of mandatory vaccination to ensure elevated vaccination coverage among HCWs.

Adverse events following immunization (AEFIs) with anti-meningococcus type B vaccine (4CMenB): Data of post-marketing active surveillance program. Apulia Region (Italy), 2019-2023.

The four-component recombinant-DNA anti-meningococcus B vaccine (4CMenB) has been approved by the European Medicines Agency in 2013. In Italy, 4CMenB is recommended since 2017 for use in infants under one year of age. Due to the strong evidence of increased risk of fever after administration, surveillance of adverse events following immunization (AEFIs) is a priority for 4CMenB. This cross-sectional prospective study aims at investigating 4CMenB's safety profile. The study population is represented by infants under twelve months of age vaccinated with 4CMenB in selected ambulatories in Apulia, a region in South-Eastern Italy, from October 1st, 2020, to March 31st, 2023. Parents were provided with a post-vaccination diary covering up to seven days after immunization and were contacted one week after the vaccination day. Information about AEFIs was collected, and reactions were classified following World Health Organization guidelines. For serious AEFIs, causality assessment was carried out. AEFI risk determinants were investigated via logistic regression. A total of 4,773 diaries were completed, with 78.13 % of them (3,729/4,773) containing one or more AEFI reports. Systemic reactions such as malaise, drowsiness/insomnia and fatigue were the most common ones, followed by fever and local pain, tenderness, redness and swelling. Twenty-three cases of serious AEFIs were reported. Following causality assessment, 78.26 % of serious adverse events (18/23) were deemed to have a consistent causal association with the administration of 4CMenB (reporting rate: 0.38 %). Three infants were hospitalized following vaccination, but no cases of death or permanent/severe impairment were reported. Prophylactic paracetamol administration showed a significant protective effect against the risk of manifesting fever within the first 24 h after administration (OR: 0.75; p < 0.005). Our data confirms existing evidence regarding the safety of 4CMenB vaccination in babies under 2 years of age, but also highlight a significant risk of fever after vaccination. Prophylactic paracetamol administration could represent a protective factor against fever, especially during the first 24 h after vaccination.

Determinants of compliance to influenza and COVID-19 vaccination in a cohort of solid organ transplant patients in Puglia, Southern Italy (2017-2022).

Influenza and Coronavirus Disease 2019 (COVID-19) vaccination are recommended in both solid organ transplant (SOT) candidates and recipients. In Puglia, Southern Italy, an active vaccination offer program has been activated targeting these patients. This study aims at investigating vaccination coverage (VC) for both vaccines in a SOT patients' cohort, as well as at identifying the vaccination compliance determinant. This is a retrospective, population-based study. The study population consists of the SOT patients who accessed Bari's "Policlinico" General Hospital during 2017-2022. Patients were contacted and, after providing their consent, asked their immunization status regarding influenza and COVID-19 and whether they had already undergone transplant or were waiting to do so. Regression models were fitted to investigate the determinants of VCs for influenza vaccination (2021/22 and 2022/23 seasons) and for COVID-19 vaccination (three-dose base cycle, first and second booster doses). Three-hundred and ten SOT patients were identified; 85.2% (264/310) had already undergone SOT. VCs were suboptimal, especially for constant yearly influenza vaccination (17.7%) and COVID-19 vaccination's second booster (1.94%). Logistic regression highlighted that influenza VCs are higher for SOT recipients than SOT candidates, as well as for older patients, although when considering both vaccination seasons only age significantly impact the vaccination uptake. Older age was the only influential variable for COVID-19 VC. VCs for SOT patients seem to be unsatisfying. Stronger interventions are required.

A Systematic Review of Population-Based Studies Assessing Knowledge, Attitudes, Acceptance, and Hesitancy of Pregnant and Breastfeeding Women towards the COVID-19 Vaccine.

The anti-SARS-CoV-2 vaccination is recommended for pregnant women due to the high risk of complications. However, pregnancy has been associated with vaccine hesitancy. Our review aims at summarizing the existing literature about anti-SARS-CoV-2 vaccine hesitancy in pregnant and lactating women. The research was conducted on PubMed/MEDLINE, ExcerptaMedica Database (EMBASE), and Scopus, according to PRISMA guidelines. Articles regarding the COVID-19 vaccine's acceptance and/or refusal by pregnant and lactating women were selected. Only observational, population-based studies were included. The Joanna Briggs Institute quality assessment tools were employed. A total of 496 articles were retrieved, and after the selection process, 21 papers were included in the current analysis. All the included studies were cross-sectional, mostly from Europe and North America. The sample sizes ranged between 72 and 25,111 subjects. All of them included pregnant subjects, except one that focused on breastfeeding women only. Vaccine hesitancy rates ranged from 26% to 57% among different studies. Fear of adverse events and lack of knowledge were shown to be the main drivers of hesitancy. Approximately half of the studies (11/21) were classified as low quality, the remaining (9/21) were classified as moderate, and only one study was classified as high quality. Primigravidae were also shown to be more likely to accept anti-SARS-CoV-2 vaccination. Our findings confirm significant anti-SARS-CoV-2 vaccine hesitancy among pregnant women. Information gaps should be addressed to contain concerns related to adverse events.

The Effects of the COVID-19 Pandemic on Vaccination Hesitancy: A Viewpoint.

Vaccination hesitancy is considered by the World Health Organization as a danger to global health. In recent years, vaccine hesitancy rates to COVID-19 have been studied worldwide. In our study, we aim to provide an overview of the concept of vaccine hesitancy, with regard to the post-COVID era, and to provide prevention and management strategies. A search of the international literature until March 2023 was conducted in the PubMed database. The 5723 papers found were divided into two groups: prior to the COVID-19 era and from 2021 onward. Papers about the vaccine hesitation phenomenon are becoming more common during the SARS-CoV-2 pandemic and following the marketing that the vaccine companies have carried out on the different types of COVID-19 vaccines. It is advisable that healthcare authorities, at the national and international level, as well as healthcare professionals, at the local level, should promote a series of activities to reduce the vaccine hesitancy rate.

Infection Control among Healthcare Workers and Management of a Scabies Outbreak in a Large Italian University Hospital.

This retrospective observational study describes the results of an ad-hoc designated prevention protocol aimed at containing the spread of the scabies infestation among healthcare workers (HCWs) of a large University Hospital in Italy. The outbreak started on October 2022 and a preventive protocol was set up thanks to a multidisciplinary approach. HCWs at high scabies risk were defined as subjects working in Operative Units with a scabies prevalence higher than 2%, close contacts of a confirmed case of scabies, or HCWs with signs and symptoms of the disease. All cases at high scabies risk underwent a dermatological examination, and the infested HCWs were suspended from work until definitive healing. Mass drug administration was established for all HCWs working in Operative Units with a scabies prevalence higher than 2%. Until March 2023, out of 183 screening dermatological examinations, 21 (11.5%) were diagnostic for scabies. Between 11 October 2022 (date of the first diagnosed scabies case) and 6 March 2023 (the end of incubation period related to the last case detected), the frequency of scabies was 0.35% (21 scabies cases/6000 HCWs). The duration of the outbreak in our hospital was 14.7 weeks. Statistical analysis shows a significant association between scabies and being a nurse and having an allergy to dust mites. We obtained a low frequency of scabies infection, limiting the duration of the outbreak and the related economic burden.

Immunogenicity and Safety of Adjuvanted Recombinant Zoster Vaccine in Rheumatoid Arthritis Patients on Anti-Cellular Biologic Agents or JAK Inhibitors: A Prospective Observational Study.

Rheumatoid arthritis (RA) patients on JAK inhibitors (JAKi) have an increased HZ risk compared to those on biologic DMARDs (bDMARDs). Recently, the Adjuvanted Recombinant Zoster Vaccine (RZV) became available worldwide, showing good effectiveness in patients with inflammatory arthritis. Nevertheless, direct evidence of the immunogenicity of such a vaccine in those on JAKi or anti-cellular bDMARDs is still lacking. This prospective study aimed to assess RZV immunogenicity and safety in RA patients receiving JAKi or anti-cellular bDMARDs that are known to lead to impaired immune response. Patients with classified RA according to ACR/EULAR 2010 criteria on different JAKi or anti-cellular biologics (namely, abatacept and rituximab) followed at the RA clinic of our tertiary center were prospectively observed. Patients received two shots of the RZV. Treatments were not discontinued. At the first and second shots, and one month after the second shot, from all patients with RA, a sample was collected and RZV immunogenicity was assessed and compared between the treatment groups and healthy controls (HCs) receiving RZV for routine vaccination. We also kept track of disease activity at different follow-up times. Fifty-two consecutive RA patients, 44 females (84.61%), with an average age (±SD) of 57.46 ± 11.64 years and mean disease duration of 80.80 ± 73.06 months, underwent complete RZV vaccination between February and June 2022 at our center. At the time of the second shot (1-month follow-up from baseline), anti-VZV IgG titer increased significantly in both groups with similar magnitude (bDMARDs: 2258.76 ± 897.07 mIU/mL; JAKi: 2059.19 ± 876.62 mIU/mL, p < 0.001 for both from baseline). At one-month follow-up from the second shot, anti-VZV IgG titers remained stable in the bDMARDs group (2347.46 ± 975.47) and increased significantly in the JAKi group (2582.65 ± 821.59 mIU/mL, p = 0.03); still, no difference was observed between groups comparing IgG levels at this follow-up time. No RA flare was recorded. No significant difference was shown among treatment groups and HCs. RZV immunogenicity is not impaired in RA patients on JAKi or anti-cellular bDMARDs. A single shot of RZV can lead to an anti-VZV immune response similar to HCs without discontinuing DMARDs.

Past and Future Influenza Vaccine Uptake Motivation: A Cross-Sectional Analysis among Italian Health Sciences Students.

Despite its effectiveness in the prevention of seasonal flu, influenza vaccination uptake remains low, even among healthcare workers (HCWs), despite their occupational risk. The aim of this study was to explore the association between main reasons for accepting or refusing influenza vaccination and the decision to receive the vaccination during both previous and following year among health sciences students. A multi-center, cross-sectional study was performed using a validated online questionnaire. Data were analyzed by performing univariable and multivariable logistic analysis. Data from over 3000 participants showed that avoiding the spread of infection to family members and the general population (aOR: 43.55), as well as to patients (aOR: 16.56) were the main reasons associated with the highest probability of taking the influenza vaccination the following year. On the contrary, not considering influenza as a severe disease was the reason associated with the lowest probability for past (aOR: 0.17) and future vaccination (aOR: 0.01). Therefore, the importance of vaccination to protect others should always be the core of vaccination campaigns for health sciences students, together with tools to increase their awareness of the severity of this disease.

Allergic adverse events following immunization: Data from post-marketing surveillance in Apulia region (South of Italy).

Introduction: Among adverse events following immunization (AEFIs), allergic reactions elicit the most concern, as they are often unpredictable and can be life-threatening. Their estimates range from one in 1,000,000 to one in 50,000 vaccine doses. This report describes allergic events following immunization reported from 2020 to 2021 in Puglia, a region in the South-East of Italy with around 4 million inhabitants. Its main objective is to describe the allergic safety profile of currently employed vaccines. Materials and methods: This is a retrospective observational study. The study period spanned from January 2020 to December 2021, and the whole Apulian population was included in the study. Information regarding AEFIs reported in Puglia during the study period was gathered from the Italian Drug Authority's pharmacovigilance database (National Pharmacovigilance Network, RNF). The overall number of vaccine doses administered was extrapolated by the Apulian online immunization database (GIAVA). Reporting rates were calculated as AEFIs reported during a certain time span/number of vaccine doses administered during the same period. Results: 10,834,913 vaccine doses were administered during the study period and 95 reports of allergic AEFIs were submitted to the RNF (reporting rate 0.88/100,000 doses). 27.4% of the reported events (26/95) were classified as serious (reporting rate 0.24/100,000 doses). 68 out of 95 (71.6%) adverse events were at least partially resolved by the time of reporting and none of them resulted in the subject's death. Conclusions: Allergic reactions following vaccination were rare events, thus confirming the favourable risks/benefits ratio for currently marketed vaccines.

Vaccine coverage for recommended vaccines among splenectomised patients in Apulia, South Italy: a retrospective cohort study.

OBJECTIVE: Splenectomised/asplenic patients have a 10-50 fold higher risk than the general population of developing overwhelming postsplenectomy infection. To control this risk, these patients have to receive a specific immunisation schedule, before or in the 2 weeks after the surgical intervention. The study aims to estimate vaccine coverage (VC) for recommended vaccines among splenectomised patients in Apulia (South Italy), and to define the determinants of vaccination uptake in this population. DESIGN: Retrospective cohort study. SETTING: Apulia, Southern Italy. PARTICIPANTS: 1576 splenectomised patients. METHODS: The Apulian regional archive of hospital discharge forms (SDOs) was used to define the splenectomised Apulian inhabitants. The study period went from 2015 to 2020. The vaccination status for Streptococcus pneumoniae (13-valent conjugate anti-pneumococcal vaccine+PPSV23), Haemophilus influenzae type b (Hib; one dose), Neisseria meningitidis ACYW135 (two doses), Neisseria meningitidis B (two doses) and influenza (at least one dose of influenza vaccine before an influenza season after splenectomy) was assessed via data collected from the Regional Immunisation Database (GIAVA). In order to define a subject as fully immunised, we considered the Centers for Diseases Control and Prevention guidelines to define the optimal immunisation status. RESULTS: Since 2015, 1576 Apulian inhabitants have undergone splenectomy; the VC for anti-Neisseria meningitidis B vaccine was 30.9%, for anti-Neisseria meningitidis ACYW135 was 27.7%, for anti-Streptococcus pneumoniae was 27.0%, for anti-Hib was 30.1%, and 49.2% received at least one dose of influenza vaccine before an influenza season after splenectomy. None of the patients splenectomised in 2015 and 2016 had received the recommended MenACYW135 and PPSV23 booster doses 5 years after completing the basal cycles. CONCLUSIONS: The results of our study highlight low VC values among Apulian splenectomised patients. The task of public health institutions is to implement new strategies aimed at increasing VC in this population, implementing educational measures for patients and families, training for general practitioners and specialists, and ad hoc communication campaigns.

Burden of COVID-19 disease and vaccine coverages in Apulian splenectomized patients: A retrospective observational study.

Splenectomy/asplenia is a condition associated with immune-compromission and specific vaccines are recommended for these patients, including the anti-COVID-19 vaccine. Among the high-risk group for which vaccination was prioritized in Italy, the immunocompromised patients after therapies or treatments were included. The Apulian regional archive of hospital discharge forms was used to define the list of splenectomized Apulian inhabitants, considering data from 2015 through 2020. The overall vaccination status of asplenic patients was assessed via data collected from the Regional Immunization Database. The history of SARS-CoV-2 infection and the infectious disease outcomes were extracted from the Italian Institute of Health platform "Integrated surveillance of COVID-19 cases in Italy". 1219 Apulian splenectomized inhabitants were included; the incidence rate of SARS-CoV-2 infection was 15.0 per 100 persons-year with a proportion of re-infection equal to 6.4%; the proportion of hospitalization was 2.9%, with a case-fatality rate of 2.6%. The vaccine coverage (VC) for the anti-COVID-19 vaccine basal routine was 64.2%, for the first booster dose was 15.4%, and for the second booster dose was 0.6%. A multifactorial approach is needed to increase the vaccination uptake in this sub-group population and to increase the awareness of the asplenia-related risks to patients and health personnel.

COVID-19 vaccination hesitancy among Italian parents: A systematic review and meta-analysis.

In May 2021, the Italian government extended the COVID-19 vaccination campaign to 12- to 18-year-old subjects and, starting December 2021, vaccines were also offered to children between 5 and 11 years-old. Despite these efforts, suboptimal vaccination coverages are reported. The purpose of this review is to estimate the proportion of parents/caregivers of children and adolescents expressing COVID-19 vaccine hesitancy in Italy. The vaccine hesitation rate among parents of minors was 55.1% (95%CI: 43.8-66.1%). A higher value was evidenced in studies focusing on children (59.9%; 95%CI = 43.7-75.1%) compared to the ones focusing on adolescents (51.3%; 95%CI = 34.5-68.0%). The main reasons for unwillingness were the belief that the vaccine was unsafe or ineffective, fear of adverse events, and considering COVID-19 a non-threatening disease. The implementation of effective communication campaigns and health educational programs on safe pediatric vaccinations is essential to support strategies to bolster vaccination confidence.

COVID-19 vaccination hesitancy in people affected by diabetes and strategies to increase vaccine compliance: A systematic narrative review and meta-analysis.

INTRODUCTION: People affected by diabetes are at higher risk for complications from certain vaccine-preventable diseases. Suboptimal vaccination coverages are reported in this population sub-group. The purpose of this study is to estimate the proportion of diabetic patients who express hesitation to the COVID-19 vaccine worldwide. METHODS: Seven studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar and Scopus databases from 2020 to 2022. The following terms were used for the search strategy: (adherence OR hesitancy OR compliance OR attitude) AND (covid* OR SARS*) AND (vaccin* OR immun*) AND (diabet*). RESULTS: The vaccine hesitation rate among persons with diabetes was 27.8 % (95 %CI = 15.6-41.9 %). In the comparison of vaccine hesitancy between sexes and educational status, the RRs were 0.90 (95 %CI = 0.71-1.15) and 0.88 (95 %CI = 0.76-1.02), respectively. The main reasons of unwillingness were lack of information, opinion that the vaccine was unsafe or not efficient, and fear of adverse events. CONCLUSIONS: In order to achieve a high vaccination coverage, multifactorial approach is needed, which requires major social, scientific and health efforts. The success of the vaccination campaign in this population depends on the capillarity and consistency of the interventions implemented.