The epidemiological surveillance of malignant mesothelioma in Italy (1993-2015): methods, findings, and research perspectives.

BACKGROUND: as a legacy of the large asbestos consumption until the definitive ban in 1992, Italy had to tackle a real epidemic of asbestos related diseases. The Italian National Registry of Malignant Mesotheliomas (ReNaM) is a permanent surveillance system of mesothelioma incidence, with a regional structure. Aims, assignments and territorial network of ReNaM are described, as well as data collection, recording and coding procedures. OBJECTIVES: to describe the Italian epidemiological surveillance system of mesothelioma incidence, to provide updated data about occurrence of malignant mesothelioma in Italy, and to discuss goals, attainments, and expectations of registering occupational cancer. DESIGN: analysis of data by malignant mesothelioma incident cases surveillance system. SETTING AND PARTICIPANTS: Italy, network of regional surveillance system, all Italian regions. MAIN OUTCOME MEASURES: a Regional Operating Centre (COR) is currently established in all the Italian regions, actively searching incident malignant mesothelioma cases from health care institutions. Occupational history, lifestyle habits, and residential history are obtained using a standardized questionnaire, administered to the subject or to the next of kin by a trained interviewer. The extent of dataset, epidemiological parameters, and occupations involved are reported updated at 31.12.2016, and standardized incidence rates are calculated. RESULTS: at December 2016, ReNaM has collected 27,356 malignant mesothelioma cases, referring to the period of incidence between 1993 and 2015. The modalities of exposure to asbestos have been investigated for 21,387 (78%) and an occupational exposure has been defined for around 70% of defined cases (14,818). CONCLUSIONS: the Italian experience shows that epidemiological systematic surveillance of asbestos related diseases incidence has a key importance for assessing and monitoring the public health impact of occupational and/or environmental hazards, programming preventive interventions, including remediation plans and information campaigns, and supporting the efficiency of insurance and welfare system. Monitoring the incidence of malignant mesothelioma through a specialized cancer registry is essential to follow-up the health effects of changing modalities and extent of occupational exposures over years and of environmental contamination. Such consolidated surveillance system is recommended also for occupational cancers with low aetiological fraction.

The epidemiology of malignant mesothelioma in women: gender differences and modalities of asbestos exposure.

INTRODUCTION: The epidemiology of gender differences for mesothelioma incidence has been rarely discussed in national case lists. In Italy an epidemiological surveillance system (ReNaM) is working by the means of a national register. METHODS: Incident malignant mesothelioma (MM) cases in the period 1993 to 2012 were retrieved from ReNaM. Gender ratio by age class, period of diagnosis, diagnostic certainty, morphology and modalities of asbestos exposure has been analysed using exact tests for proportion. Economic activity sectors, jobs and territorial distribution of mesothelioma cases in women have been described and discussed. To perform international comparative analyses, the gender ratio of mesothelioma deaths was calculated by country from the WHO database and the correlation with the mortality rates estimated. RESULTS: In the period of study a case list of 21 463 MMs has been registered and the modalities of asbestos exposure have been investigated for 16 458 (76.7%) of them. The gender ratio (F/M) was 0.38 and 0.70 (0.14 and 0.30 for occupationally exposed subjects only) for pleural and peritoneal cases respectively. Occupational exposures for female MM cases occurred in the chemical and plastic industry, and mainly in the non-asbestos textile sector. Gender ratio proved to be inversely correlated with mortality rate among countries. CONCLUSIONS: The consistent proportion of mesothelioma cases in women in Italy is mainly due to the relevant role of non-occupational asbestos exposures and the historical presence of the female workforce in several industrial settings. Enhancing the awareness of mesothelioma aetiology in women could support the effectiveness of welfare system and prevention policies.

Seasonal influenza vaccination in pregnant women: knowledge, attitudes, and behaviors in Italy.

BACKGROUND: The aims of this study were to assess the knowledge, attitudes, and behaviors towards seasonal influenza and its vaccination among pregnant women. METHODS: A cross-sectional survey was carried out among a sample of women in the second or third trimester of pregnancy in Italy. RESULTS: The 64.2% of the sample knew that the influenza is more dangerous for pregnant women. Women of older age, Italian, and who had a pregnancy at high-risk were more likely to have this knowledge. This knowledge was lower among women with none, primary or secondary school education. The majority of the respondents considered the vaccine not very useful during pregnancy. Those younger, unmarried, who knew that influenza is more dangerous for pregnant women, who knew that the vaccine could protect them, who reported a higher self-rated health status, and who had received information about influenza and its vaccination were more likely to have a positive attitude toward the usefulness of influenza vaccination in pregnancy. Women with secondary school education and with more than one child revealed a lower perception. Only 9.7% had received the vaccine and 21.4% of those unvaccinated would be willing to receive it. This positive attitude was higher among women with one child, who knew that the vaccine could protect them against the influenza, and who have a positive attitude toward the usefulness of the vaccination during pregnancy. CONCLUSIONS: Health educational programs are needed to improve the knowledge about seasonal influenza and vaccination rate in pregnancy.

Medication adherence among patients with chronic conditions in Italy.

BACKGROUND: The aims of the cross-sectional study were to measure the extent of adherence to prescribed medications among patients affected by chronic diseases and to identify the predictors of the adherence. METHODS: The study was conducted between March and December 2014 among 633 outpatients in four hospitals in Italy. Data were collected using a face to face interview at the time of their visit to the hospital. The Morisky Medication Adherence 4-item Scale was used to measure patients' self-reported adherence. RESULTS: The majority of the patients were male (51.7%), the mean age was 63.2 years, one-third had at least a high school diploma or equivalent, 34.6% was employed, and the main diseases were hypertension, diabetes, and chronic obstructive pulmonary disease. A total of 39.3% patients reported themselves as being adherent to medications over the 4 weeks preceding their medical specialist's visit. Patients were more likely to adhere to medications if they had a college degree or higher level of education, a higher score of the Katz index, took a lower number of total pills per day, and did not use pill organizers. Patients who have never forgotten to take medications over the 4 weeks preceding their medical specialist's visit were 46.1%. CONCLUSIONS: The findings emphasize the need for improving information for the individuals affected by chronic diseases concerning the risks of non-adherence in order to encourage responsible behaviour to prescribed medications.

Hepatitis B virus, hepatitis C virus and human immunodeficiency virus infection in undocumented migrants and refugees in southern Italy, January 2012 to June 2013.

Screening of undocumented migrants or refugees for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections has been offered free of charge and free from bureaucratic procedures since 2012 at four primary-level clinical centres in Naples and Caserta, Italy. Of 926 undocumented migrants and refugees visiting one of the primary-level clinical centres from January 2012 to June 2013, 882 (95%) were screened for hepatitis B surface antigen (HBsAg), total hepatitis B core antibody (anti-HBc) and antibodies against HCV and HIV. Of the 882 individuals enrolled, 78 (9%) were HBsAg positive, 35 (4%) anti-HCV positive and 11 (1%) anti-HIV positive (single infections); seven (1%) had more than one infection (three were HBsAg positive). Of the 801 HBsAg-negative patients, 373 (47%) were anti-HBc positive. The HBsAg-positivity rate was high (14%; 62/444) in individuals from sub-Saharan Africa and intermediate in those from eastern Europe (6%; 12/198), northern Africa (2%; 2/80) and Bangladesh, India, Pakistan and Sri Lanka (the 'India-Pakistan area') (3%; 4/126). Anti-HCV was detected in 9/126 (7%) individuals originating from the India-Pakistan area, in 12/198 (6%) from eastern Europe, in 17/444 (4%) from sub-Saharan and in 2/80 (2%) from northern Africa. The HBV, HCV and HIV infections in the undocumented migrants and refugees screened serve as a reminder to the Italian healthcare authorities to carry out extensive screening and educational programmes for these populations.

Knowledge, Attitudes, and Coverage of Recommended Vaccinations in Individuals with Chronic Medical Conditions: A Cross-Sectional Telephone Survey in Italy.

BACKGROUND: This cross-sectional survey investigated the knowledge, attitudes, and coverage of recommended vaccinations among a random sample of patients with chronic medical conditions, at higher risk of vaccine-preventable diseases (VPDs), in Italy. METHODS: The survey was conducted via telephone-based interviews. RESULTS: Multinomial regression analysis showed that the patients who believed that VPDs were severe were more likely to know one recommended vaccination; those who believed that VPDs were severe and those who were advised from a general practitioner (GP) were more likely to know two vaccinations; those who were older, graduated, with more time from diagnosis, who believed that VPDs were severe, who did not need additional information, and who were advised from a GP were more likely to know three or four vaccinations. Patients who knew at least one vaccination, who perceived themselves at risk, and who were advised from a GP were more likely to have received one vaccination; those who knew more than one vaccination and who were advised from a GP were more likely to receive two or three vaccinations. Among the unvaccinated, patients who were unmarried/not cohabiting, those who needed information, and who believed that vaccinations were useful and safe were more willing to receive the recommended vaccinations. CONCLUSIONS: Educational interventions are needed to improve the adherence of individuals with chronic medical conditions.

Impact of the COVID-19 pandemic on behavioral changes in healthcare workers in Italy.

Introduction: During the COVID-19 pandemic, adherence to wearing face mask and washing hands procedures and achieving high COVID-19 vaccine coverage among healthcare workers (HCWs) were essential to minimize morbidity and possible death and limit the transmission of the virus. The objectives of the cross-sectional survey were to explore the influence of COVID-19 on the use of preventive measures and vaccination willingness among HCWs in the southern part of Italy and the associated factors. Methods: The survey was carried out from 15 June 2023 to 15 July 2023 among 521 HCWs who worked in three randomly selected public hospitals. All data were collected through a self-administered questionnaire. Results: HCWs had a positive change in the use of preventive measures if they did not often/always use them before the pandemic, but they are using in the current epidemiologic context and they were willing to use in a future epidemic situation. A positive change in the adherence to face mask-wearing (24.6%) was more likely among those with at least 5 years of university degree, nurses/midwives, and who had worked in COVID-19 wards. A positive change in alcohol-based hand rubbing (3.1%) was more likely in HCWs in Emergency/Critical/Infectious Diseases wards compared with medical wards. HCWs who were more likely to believe that the COVID-19 vaccine should be mandatory for them (58.1%) had at least 5 years of university degree, in Emergency/Critical/Infectious Diseases wards compared with surgical and medical wards, had received more than three doses of this vaccine, were more concerned to get infected during their activity, and had received information from scientific journals. HCWs more willing to receive the COVID-19 vaccine every year (39.8%) were males, physicians, those in Emergency/Critical/Infectious Diseases wards compared with medical wards, who had received more than three doses of this vaccine, who believed that this vaccine should be mandatory for HCWs, and who needed additional information. Discussion: The survey showed that the COVID-19 pandemic had an impact on the use of preventive measures among HCWs, not necessarily for the improvement or increase. Educational messages on the importance of these measures regarding the promotion and recommendation of the vaccine need to be investigated and applied among HCWs in order to reduce vaccination gaps and the spread of the infection.

Genital and Oral HPV Geno-Prevalence Measured through Urine and Saliva Samples in Young Adults in Italy.

BACKGROUND: The aims of the study were to determine, in the urine and oral samples of young adults, the genotype-specific prevalence of Human Papilloma Virus (HPV) infection, the HPV DNA type-specific prevalence in unvaccinated and vaccinated individuals, and the determinants of HPV infection. METHODS: Selected participants were asked to fill in a self-administered questionnaire and to self-collect urine and saliva samples. RESULTS: Among the 1002 participants, 81 (8.1%) resulted positive for HPV DNA. The most common low-risk genotype was HPV 42 (2.2%), followed by HPV 43 (0.8%), and 40 (0.5%). The HPV 51 was the most common high-risk genotype (1.5%) followed by HPV 66 (1%) and HPV 68 (1%), and no participants were infected with HPV genotypes 18, 33, 45. Females, those who have had one or more occasional sexual partner, those who never/rarely/sometimes used condoms during their sexual activity, those with a previous diagnosis of sexually transmitted infection, and those who were not vaccinated were more likely to be tested positive for HPV infection. CONCLUSIONS: The low prevalence of genital HPV infections has provided evidence of the effectiveness of HPV vaccination both in vaccinated and not yet vaccinated subjects through herd immunity and indicated its decisive role in the changing epidemiology of circulating HPV genotypes in the population.

Candida spp. in oral cancer and oral precancerous lesions.

To assess the presence of Candida spp. in lesions of the oral cavity in a sample of patients with precancer or cancer of the mouth and evaluate the limitations and advantages of microbiological and histological methods, 103 subjects with precancerous or cancerous lesions and not treated were observed between 2007 and 2009. The presence of Candida in the lesions was analyzed by microbiological and histological methods. Cohen's k statistic was used to assess the agreement between culture method and staining techniques. Forty-eight (47%) patients had cancer and 55 (53%) patients had precancerous lesions. Candida spp. were isolated from 31 (30%) patients with cancerous lesions and 33 (32%) with precancerous lesions. C. albicans was the most frequent species isolated in the lesions. The k value showed a fair overall agreement for comparisons between culture method and PAS (0.2825) or GMS (0.3112). This study supports the frequent presence of Candida spp. in cancer and precancerous lesions of the oral cavity. Both microbiological investigations and histological techniques were reliable for detection of Candida spp. It would be desirable for the two techniques to be considered complementary in the detection of yeast infections in these types of lesions.

Analysis of the COVID-19 vaccine willingness and hesitancy among parents of healthy children aged 6 months-4 years: a cross-sectional survey in Italy.

Introduction: In Italy, since December 2022, the COVID-19 vaccination has been extended to children aged 6 months-4 years with conditions of fragility and to those healthy at the request of the parent. The purposes of the cross-sectional survey were to determine the willingness and hesitancy of the parents/guardians to have their healthy children vaccinated against COVID-19. Methods: The survey was performed among 389 parents/guardians with a child aged 6 months-4 years randomly selected from seven kindergartens and eight nursery schools in the geographic area of Naples, Italy. Results: Only 10.5% were very concerned about the risk of infection, and the mean values regarding the perceived utility and safety of the COVID-19 vaccine were 3.3 and 3.2, respectively. Only 13.7% of participants were willing to consent to vaccinate the selected child against COVID-19, while 20.1% were uncertain and 66.2% did not intend. Parents/guardians of older children, those who received information about the COVID-19 vaccine from physicians or pediatricians, those who believed that the COVID-19 vaccine was useful, and those with lower hesitancy regarding the COVID-19 vaccine were more willing to vaccinate their child. The mean Parent Attitudes About Childhood Vaccines (PACV-5) score was 5.6, with 33.1% of respondents who were identified as highly hesitant toward COVID-19 vaccination (score ≥ 7). Parents/guardians with a lower perceived safety of the COVID-19 vaccine were more likely to be highly hesitant. Discussion: The findings reveal the need to improve community-based education campaigns and effective promotion of the COVID-19 vaccination to increase willingness and address parental safety concerns.

Willingness and hesitancy of parents to vaccinate against COVID-19 their children ages 6 months to 4 years with frail conditions in Italy.

Background: In Italy, on December 2022, COVID-19 vaccination was recommended for children aged 6 months-4 years with frail conditions and for those healthy. The purposes of the survey were to understand parental willingness and hesitancy toward COVID-19 vaccination of children with frail conditions in Italy and related influencing factors. Methods: A cross-sectional survey was performed among 445 parents with a child aged 6 months-4 years with frail conditions who attended a teaching hospital and a public hospital randomly selected in the city of Naples, Italy. Results: Almost one third (29.9%) were willing to vaccinate their frail children against COVID-19, whereas 21.3% were uncertain, and 48.8% did not intend to vaccinate. Parents with a higher level of perception that the vaccine is useful and safe and those who had received information by pediatrician were more likely to be willing to vaccinate their child. The mean Parent Attitudes About Childhood Vaccines (PACV-5) score was 3.4, with 13.5% of parents high-hesitant for the COVID-19 vaccination for their child. Parents with a higher COVID-19 vaccine-related safety concerns, those who have delayed at least one shot of a recommended vaccine for their child, and those who did not have received at least three doses of the vaccine against SARS-CoV-2 were more likely to be high-hesitant. Conclusion: The survey findings have important implications for designing interventions to increase willingness and to reduce hesitancy for COVID-19 vaccine among parents of frail children aged 6 months-4 years in Italy.

Parents' Uptake and Willingness towards Recommended Vaccinations for Their Children with Underlying Chronic Medical Conditions in Italy.

This cross-sectional survey was conducted to investigate the willingness and uptake of recommended vaccinations against influenza, meningococcal B and ACWY, pneumococcal, rotavirus and the influencing factors among 565 parents of children aged 6 months to 5 years with chronic medical conditions in Italy. Only 34.9% of the sample received all vaccinations. Parents whose selected child was vaccinated against the five diseases were those who had received recommendations from physicians, who did not believe that children should get fewer vaccinations at the same time, those whose child was aged 2-3 and 4-5 years compared to 6 months-1 year, and those who acquired information from physicians. Only 17.9% were willing to vaccinate their child. Parents with a university degree, those who acquired information from physicians, and those whose child had a more recent diagnosis were more likely to be willing to vaccinate their child. Parents who believed that children should get fewer vaccines at the same time, those without a university degree, and those who did not acquire information from physicians were more likely to not have vaccinated their child because they were concerned about vaccines' side effects. Public health policymakers should provide efforts to promote the uptake for an adequate protection of this high-risk group.

Investigating the Reasons for Receiving the Second Booster Dose of the COVID-19 Vaccine in Adults and in People with Chronic Medical Conditions in Southern Italy.

This cross-sectional survey explored the attitudes and the reasons, as well their associated factors, for receiving the second booster dose of the COVID-19 vaccine among a sample of all old adults and of people with chronic medical conditions attending two randomly selected immunization centers in Naples (Italy). A total of 438 questionnaires were collected. The majority were male (55.1%) and the median age was 71 years. A higher perception of the vaccine's utility, measured with a 10-point Likert type scale, has been observed among males, individuals with a higher perception that COVID-19 is a severe illness, with a higher self-awareness of being at risk of infection, and with a higher trust in the information received. The most reported reasons for receiving the second booster dose included protection of themselves and of their family members from getting COVID-19, fear of acquiring the disease, and having a physician's recommendation. Younger participants, married/cohabitant, and with a higher perception that COVID-19 is a severe illness were more likely to have indicated protecting themselves and their family members as reason for receiving the booster dose. Respondents with a chronic medical condition, with a higher perception that COVID-19 is a severe illness, with a lower trust in the information received, and informed by physicians were more likely to have received the vaccine because they perceived of being at risk of getting a severe form of the SARS-CoV-2 infection. Physicians should play a pivotal role in stressing the importance of the second booster dose and in helping individuals to make decisions.

Bivalent second booster dose of the COVID-19 vaccine: Eligible populations' reasons for receiving in Italy.

The Italian Ministry of Health recommended the administration of the bivalent second booster dose of the new available mRNA COVID-19 vaccine for subjects aged 60 y and over, aged 12 y and over with high frailty motivated by concomitant/preexisting conditions, and health-care workers. The purposes of this cross-sectional survey were to investigate the reasons for receiving the bivalent second booster dose of the COVID-19 vaccine and associated influencing factors among the eligible population attending two immunization centers randomly selected in the city of Naples, Italy. A total of 535 subjects participated. Only 17.5% revealed high concern about the possibility of acquiring the COVID-19 disease. Those younger, those who had at least one chronic medical condition, and those who had a higher perceived seriousness of the COVID-19 disease were more likely to be very concerned. Having a higher belief of the vaccine's safety and usefulness were significant positive predictors of the respondents' belief of the efficacy of the bivalent second booster dose. The two most common reasons reported for receiving the bivalent second booster dose included the protection for themselves and for their cohabitants. Those younger and those who had a higher perception of the vaccine's usefulness in preventing SARS-CoV-2 infection were more likely to receive the bivalent second booster dose for the protection of their cohabitants. Health-care organizations and health-care professionals can use these findings in their efforts to design educational and communication interventions to accelerate the uptake of this vaccine for reducing the frequency of this disease.

Knowledge and attitudes of health care workers about monkeypox virus infection in Southern Italy.

Background: This present survey sought to investigate the level of knowledge and the attitudes pertaining the monkeypox (mpox) virus infection among a sample of health care workers (HCWs) in Italy, as well as the possible role of different factors on these outcomes. Methods: The cross-sectional survey was performed from July through October, 2022 at four randomly selected hospitals located in Southern Italy. Results: The questionnaire was completed by 421 HCWs, for an overall 59% response rate. Less than two-thirds were able to define the disease and the correct answer of the transmission mechanisms ranged from 22.8% for contact with contaminated objects to 75.8% through close contact with body fluids. Only 4% and 12.8% indicated HCWs and elderly/frail/people with underlying immune deficiencies as risk groups. The mean overall score of the knowledge assessment on mpox was 3.4 (0-9). The multivariate logistic regression analysis showed that HCWs with a lower number of years of working experience and those who had acquired information about mpox from scientific journals were more likely to have a higher level of knowledge. The average score of the perception of the severity of the disease was 6.3. A similar score with a value of 6.1 has been observed for the statement that mpox is a serious problem for the population. Regarding the level of concern about contracting mpox, the mean score was 5.1. Only 10.5% reported that they feel that this disease can be prevented, with an overall mean score of 6.5. Almost all HCWs reported that they are still living as usual, with no modification of their behavior for fear of contracting the mpox. The results of the multivariate logistic regression model showed that women, HCWs with a higher level of knowledge about mpox, and those who needed additional information about mpox were more likely to have a higher level of perception of the severity of the disease. Conclusion: This survey has demonstrated that HCWs had an unsatisfactory level of knowledge toward mpox and only nearly half showed positive attitudes. Strategic health training programs should be made so that knowledge can be acquired.

Midwives' Knowledge, Attitudes, and Practice Regarding COVID-19 Vaccination for Pregnant Women: A Nationwide Web-Based Survey in Italy.

This cross-sectional survey investigated the knowledge, attitudes, and practices concerning the COVID-19 vaccination for pregnant women among midwives in Italy and the associated factors. Midwives with at least five years of midwifery education and who had received information about the COVID-19 vaccination from official government organizations or scientific journals were more likely to know in which trimester this vaccine can be administered. A higher perceived utility of this vaccination was observed among midwives working in the public sector, in those concerned by being infected by SARS-CoV-2, who have received at least one dose of this vaccination, in those who considered COVID-19 a severe disease for pregnant women and their fetus, and who believed that the vaccination is safe. One-third of the midwives routinely provided information and half recommended this vaccination. Midwives with more years of activity, who received information about the vaccination from official government organizations or scientific journals, those who had never assisted patients with SARS-CoV-2, and those who believed in midwives' role in COVID-19 prevention were more likely to routinely provide information. Participants who perceived a higher utility of this vaccination, those who believed in midwives' role in COVID-19 prevention, those who received information from official government organizations or scientific journals were more likely to routinely provide a recommendation for the vaccine. Midwives' knowledge must be improved for ensuring that they communicate and recommend the vaccination to their patients.

Evaluating Knowledge, Attitudes, and Behaviors toward HPV Infection and Vaccination among University Students in Italy.

BACKGROUND: This survey investigated the knowledge, attitudes, and behaviors towards HPV preventive measures among university students in Italy and their associated factors. METHODS: The cross-sectional survey was conducted between November 2022 and April 2023. RESULTS: Only 41.7% knew about HPV infection and the main preventive measures. Multilevel mixed-effects logistic regression analysis showed that females, those aged 25-30 years, those who have had oral sex, those who had received information about HPV infection and preventive measures from physicians, and those who needed additional information about HPV infection and preventive measures were more knowledgeable. Only 39.1% have received at least one HPV vaccination dose, whereas 29.2% and 31.7% had not been vaccinated or did not remember. Multilevel mixed-effects logistic regression analysis identified that female students enrolled in the field of health sciences, those who did not report a prior history of a sexually transmitted infection, and those with a higher knowledge about HPV infection and preventive measures were more willing to receive the HPV vaccination. CONCLUSIONS: Despite some limitations, this was the first detailed survey on this topic conducted in the post-acute phase of COVID-19 among university students in Italy. The survey underlined the need to develop and to implement comprehensive educational programs and health interventions among students, to enhance their knowledge and modify their attitudes and improve the HPV vaccine uptake.

The Impact of COVID-19 Vaccination in Changing the Adherence to Preventive Measures: Evidence from Italy.

The objectives of the survey were to explore any changes in the adherence to the three main COVID-19 preventive measures (social distancing, washing hands, wearing face-masks) among 795 individuals who received the COVID-19 vaccine booster dose in Italy and to identify the predictors associated. The concern of contracting COVID-19 before the vaccination, after the primary COVID-19 vaccine series, and after the booster dose resulted with a mean value of 7.7, 4.6, and 4.2, respectively. Females, those who had a lower mean self-perceived health status, who perceived COVID-19 as a very serious health problem, who decided to receive the booster dose because they perceived to be at risk of getting COVID-19, and who expressed interest in acquiring more information regarding the COVID-19 vaccine booster dose were more likely to report a higher concern of contracting COVID-19 after the booster dose. Over two-thirds were willing to respect the three main COVID-19 preventive measures following the booster dose. The multinomial logistic regression analysis showed that those who had used all three main preventive measures before and after the second or single dose were less likely to perceive COVID-19 as a serious illness. Those who had used them irregularly were less likely to have used official government organizations and scientific journals as sources of information. This survey provided an understanding regarding the adherence to COVID-19 preventive measures that may help to target policy interventions needed to reduce the spread of SARS-CoV-2.

Evaluating COVID-19 Vaccine Willingness and Hesitancy among Parents of Children Aged 5-11 Years with Chronic Conditions in Italy.

COVID-19 vaccination has been extended to include children aged 5-11 years. This cross-sectional survey evaluated parental COVID-19 vaccine willingness and hesitancy, and associated factors, for their children aged 5-11 years with chronic conditions. A telephone survey was conducted from 14 December 2021 to 4 January 2022. The questionnaire assessed participants' socio-demographic and health-related information, attitudes towards COVID-19 infection, hesitancy, by using the PACV-5 (Parent Attitudes About Childhood Vaccines Survey Tool), and sources of information. A total of 430 answers were collected anonymously. Respondents with no cohabitant who had been infected by SARS-CoV-2 and having been vaccinated against COVID-19 had a higher concern about the severity of COVID-19. The parents' perceived risk that the child could be infected by SARS-CoV-2 was higher in those more concerned about the severity of COVID-19, with an older child, and who had at least one cohabitant positive for COVID-19. Only 38.8% parents were willing to vaccinate their children against COVID-19. Parents who did not need additional information, those with higher education, those who have been vaccinated against COVID-19, those whose child was older, who had received information on this vaccination from physicians, with higher self-reported concern about the severity of COVID-19, and who had a higher perceived risk that their child could be infected by SARS-CoV-2, expressed a greater willingness to vaccinate their child. Overall, 26.3% were high-hesitant, with a PACV-5 score ≥ 7. Respondents who did not get the COVID-19 vaccine, were less educated, with a lower concern about severity of COVID-19, and with a lower perceived risk that their child could be infected by SARS-CoV-2, were more likely to be high-hesitant. New policies and educational programs regarding COVID-19 vaccination for children with chronic conditions are needed to reduce hesitancy and increase vaccination uptake.