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 regu-lation 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.

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.

Anti-SARS-CoV-2 antibody decay after vaccination and immunogenicity of the booster dose of the BNT162b2 mRNA vaccine in patients with psoriatic arthritis on TNF inhibitors.

OBJECTIVES: Scanty data on the anti- SARS-CoV-2 IgG level decay after two-dose BNT162b2 vaccination have been published in patients with psoriatic arthritis (PsA) on TNF inhibitors (TNFi). Similarly, no reports on the immunogenicity of a booster dose in such patients have been provided yet.We aimed to investigate the IgG level decay after two-dose BNT162b2 vaccination and the immunogenicity and safety of the booster dose in PsA patients on TNFi. METHODS: Forty patients with classified PsA on TNFi undergoing booster dose with the BNT162b2 mRNA SARS- CoV-2 vaccine (BioNTech/Pfizer) were enrolled. Fifteen days after the third shot, serum IgG levels against SARS-CoV-2 (Abbott®ARCHITECT i2000SR, positivity cut-off 50 AU/mL) were assayed in all patients. Clinimetrics and treatment data were gathered. TNFi treatment was not discontinued. Sera from healthcare professionals were considered as healthy controls for 1:1 propensity score-matching. Student's t-test and logistic regression were used for investigating differences in immunogenicity between groups and predictors of antibody response. RESULTS: Even though the decay of IgG levels showed similar magnitude between groups, PsA patients had a lower IgG level than matched controls at 4 months after two-dose vaccination (2009.22±4050.22 vs. 6206.59±4968.33 AU/mL, respectively p=0.0006). Booster dose restored IgG levels to a similar extent in both groups (15846.47±12876.48 vs. 20374.46±12797.08 AU/ml p=0.20, respectively). Clinical Disease Activity Index (CDAI) did not change before and after vaccination (6.68±4.38 vs. 4.95±4.20, p=0.19). CONCLUSIONS: A BNT162b2 booster dose should be recommended in PsA patients on TNFi as its administration restores anti-SARS-CoV-2 IgG levels similar to healthy individuals.

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.

Immunogenicity and safety of the BNT162b2 COVID-19 mRNA vaccine in PLWH: A monocentric study in Bari, Italy.

In March, people living with HIV infection (PLWH) were included in the risk category of fragile people for severe COVID-19 receiving priority access to vaccination with BNT162b2 vaccine. The aim of the study was to evaluate the immunogenicity and safety of the two doses regimen. The antibodies titer for severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) was evaluated after 21 days since the first administration (Time 1), 1 (Time 2), and 3 (Time 3) months post-vaccination. Information regarding virological and immunological conditions at baseline, previous SARS-CoV-2 state of infection, other immunodeficiencies, current antiretroviral therapy (ART), comorbidities, and severe adverse events (SAE) to vaccination was collected. Six hundred and ninety-seven patients were tested for quantitative anti-spike antibodies at Time 1, 577 patients had a second detection at Time 2, and 491 patients had the third detection. Baseline characteristics of the study population are reported in Table 1. At the time of vaccine administration, all patients were on ART (except one long-term nonprogressor); 632 (90.7%) patients had undetectable HIV-RNA; 12 (1.7%) patients were immunosuppressed due to chemotherapy or other immunosuppressive drugs; 345 (49.5%) patients had at least one COVID-19 related comorbidity and 155 (22.2%) had two or more comorbidities. No SAEs were reported. Final serological results are available for 694 patients after the first dose, 577 and 491 after the second and third ones, respectively; positive titer (values ≥ 50 AU/ml) was demonstrated in 653 (94.1%), 576 (99.8%), 484 (98.6%) patients, respectively. Only one patient was a nonresponder after completing vaccination, who was a newly diagnosed one for HIV infection. All vaccinations were well tolerated, with no SAEs. BNT162b2 mRNA vaccine was immunogenic and safe in PLWH.

A large cross-sectional survey of COVID-19 vaccination willingness amongst healthcare students and professionals: Reveals generational patterns.

AIMS: To determine coronavirus disease 2019 (COVID-19) vaccination hesitancy in healthcare professionals and healthcare students in Italy across four generations (baby boomers, generations X, Y and Z). DESIGN: A cross-sectional descriptive study was performed through an online survey conducted from May to June 2021. The STROBE guidelines were adopted for reporting. METHODS: Data were collected by initially sending a survey link to a convenience sample of healthcare professionals and students, which was followed by snowball sampling. The VAX scale was validated and adopted. An ANOVA was performed to detect differences in vaccine-hesitancy beliefs between the four generational groups. RESULTS: The survey was completed by 1226 healthcare professionals and students. Worries about unforeseen future effects accounted for the higher vaccination hesitancy factor across generations. More positive attitudes towards COVID-19 vaccination were expressed by members of generation Z than by members of generation Y and baby boomers. Members of generation X had the highest vaccination hesitancy scores in the overall scale. CONCLUSION: The results suggest that public health campaigns should take into account the generational differences in COVID-19 vaccination hesitancy to achieve higher levels of vaccine acceptance, including amongst healthcare professionals and students. IMPACT: Vaccination is the most effective strategy to tackle the COVID-19 pandemic. The advice of health professionals strongly influences vaccination willingness in the general population. A consideration of the generational patterns in the COVID-19 vaccination hesitancy of healthcare workers and students may increase vaccination uptake in these populations, which in turn may lead to greater public acceptance of the vaccine.

Effectiveness of SARS-CoV-2 Vaccines for Short- and Long-Term Immunity: A General Overview for the Pandemic Contrast.

BACKGROUND: The recent COVID-19 pandemic produced a significant increase in cases and an emergency state was induced worldwide. The current knowledge about the COVID-19 disease concerning diagnoses, patient tracking, the treatment protocol, and vaccines provides a consistent contribution for the primary prevention of the viral infection and decreasing the severity of the SARS-CoV-2 disease. The aim of the present investigation was to produce a general overview about the current findings for the COVID-19 disease, SARS-CoV-2 interaction mechanisms with the host, therapies and vaccines' immunization findings. METHODS: A literature overview was produced in order to evaluate the state-of-art in SARS-CoV-2 diagnoses, prognoses, therapies, and prevention. RESULTS: Concerning to the interaction mechanisms with the host, the virus binds to target with its Spike proteins on its surface and uses it as an anchor. The Spike protein targets the ACE2 cell receptor and enters into the cells by using a special enzyme (TMPRSS2). Once the virion is quietly accommodated, it releases its RNA. Proteins and RNA are used in the Golgi apparatus to produce more viruses that are released. Concerning the therapies, different protocols have been developed in observance of the disease severity and comorbidity with a consistent reduction in the mortality rate. Currently, different vaccines are currently in phase IV but a remarkable difference in efficiency has been detected concerning the more recent SARS-CoV-2 variants. CONCLUSIONS: Among the many questions in this pandemic state, the one that recurs most is knowing why some people become more seriously ill than others who instead contract the infection as if it was a trivial flu. More studies are necessary to investigate the efficiency of the treatment protocols and vaccines for the more recent detected SARS-CoV-2 variant.

BNT162b2 mRNA COVID-19 Vaccine Effectiveness in the Prevention of SARS-CoV-2 Infection: A Preliminary Report.

In the preregistration trial, data on efficacy of BNT162b2 mRNA vaccine against SARS-CoV-2 infection were not collected. This study aimed to evaluate vaccine effectiveness (VE) against documented infection. Bari Policlinico University Hospital health care workers (HCWs) who completed the vaccination schedule were matched with HCWs who had refused vaccination. VE for documented infection was 61.9% (95% confidence interval [CI], 19.2%-82.0%) 14-20 days after first dose, 87.9% (95% CI, 51.7%-97.0%) 21-27 days after first dose, and 96.0% (95% CI, 82.2%-99.1%) 7 or more days after second dose. Unvaccinated HCWs remain a concern in the context of the pandemic emergency.

Long -term persistence of antibodies against varicella in fully immunized healthcare workers: an Italian retrospective cohort study.

BACKGROUND: Chickenpox is a highly contagious disease caused by the varicella zoster virus (VZV), and in infants, adolescents, adults, pregnant women, and the immunocompromised it can be serious. The best way to prevent chickenpox is immunization with the varicella vaccine. Protective levels of antibodies induced by the varicella vaccine decline over time, but there is currently no formal recommendation for testing anti-varicella zoster virus (VZV) IgG levels in immunized healthcare workers (HCWs). METHODS: The aims of this study were to evaluate the seroprevalence of circulating anti-VZV IgG in a sample a sample of students and residents of the medical school of the University of Bari, the long-term immunogenicity of the varicella vaccine, and the effectiveness of a strategy consisting of a third vaccine booster dose. The study population was screened as part of a biological risk assessment conducted between April 2014 and October 2020. A strategy for the management of non-responders was also examined. RESULTS: The 182 students and residents included in the study had a documented history of immunization (two doses of varicella vaccine). The absence of anti-VZV IgG was determined in 34% (62/182; 95%CI = 27.2-41.4%), with serosusceptibility more common among males than females (p < 0.05). After a third varicella dose, seroconversion was achieved in 100% of this previously seronegative group. No serious adverse events were recorded. CONCLUSIONS: One-third of the study population immunized against VZV lacked a protective antibody titer, but a third dose of vaccine restored protection. Since it is highly unlikely that VZV will be eliminated in the immediate future, the loss of immunity in a substantial portion of the population implies a risk of varicella outbreaks in the coming years. Screening for varicella immunity in routine assessments of the biological risk of medical students and HCWs may help to prevent nosocomial VZV infections.

Large-scale IgM and IgG SARS-CoV-2 serological screening among healthcare workers with a low infection prevalence based on nasopharyngeal swab tests in an Italian university hospital: Perspectives for public health.

BACKGROUND: Healthcare workers (HCWs) are highly exposed to SARS-CoV-2 infection given their specific tasks. The IgG-IgM serological assay has demonstrated good accuracy in early detection in symptomatic patients, but its role in the diagnosis of asymptomatic patients is uncertain. The aim of our study was to assess IgM and IgG prevalence in sera in a large cohort of HCWs previously subjected to Nasopharyngeal swab test (NST) after accurate risk assessment due to positive COVID-19 patient exposure during an observation period of 90 days. METHODS: 2407 asymptomatic HCWs that had close contact with COVID-19 patients in the period between April 8th and June 7th were screened with NST based on the RT-PCR method. In parallel, they underwent large-scale chemiluminescence immunoassays involving IgM-IgG serological screening to determine actual viral spread in the same cohort. RESULTS: During the 90-day observation period, 18 workers (0.75%) resulted positive for SARS-CoV-2 infection at the NST, whereas the positivity rates for IgM and IgG were 11.51% and 2.37%, respectively (277 workers). Despite high specificity, serological tests were inadequate for detecting SARS-CoV-2 infection in patients with previous positive NST results (IgM and IgG sensitivities of 27.78% and 50.00%, respectively). CONCLUSIONS: These findings indicate a widespread low viral load of SARS-CoV-2 among hospital workers. However, serological screening showed very low sensitivity with respect to NST in identifying infected workers, and negative IgG and IgM results should not exclude the diagnosis of COVID-19. IgG-IgM chemiluminescence immunoassays could increase the diagnosis of COVID-19 only in association with NST, and this association is considered helpful for decision-making regarding returning to work.

Long-term Immunogenicity of Measles Vaccine: An Italian Retrospective Cohort Study.

BACKGROUND: Levels of antibodies induced by the measles virus-containing vaccine have been shown to decline over time, but there is no formal recommendation about testing immunized subjects (in particular, healthcare workers [HCWs]) to investigate the persistence of measles immunoglobulin G (IgG). METHODS: This study aims to evaluate the long-term immunogenicity of measles vaccine in a sample of medical students and residents of the University of Bari who attended the Hygiene Department for a biological risk assessment (April 2014-June 2018). RESULTS: Two thousand immunized (2 doses of measles-mumps-rubella [MMR] vaccine) students and residents were tested; 305 of these (15%) did not show protective anti-measles IgG. This proportion was higher among subjects who received vaccination at ≤15 months (20%) than in those who received vaccination at 16-23 months (17%) and at ≥24 months (10%) (P < .0001). After an MMR vaccine booster dose, we noted a seroconversion of 74% of seronegative HCWs. The overall seroconversion rate after a second dose (booster) was 93%. No serious adverse events were noted after the booster doses. CONCLUSIONS: An important proportion of subjects immunized for measles do not show a protective IgG titer in the 10 years after vaccination. Our management strategy seems consistent with the purpose of evidencing immunological memory.

Immunity to rubella: an Italian retrospective cohort study.

BACKGROUND: International guidelines recommend that healthcare workers (HCWs) have presumptive evidence of immunity to rubella and that susceptible HCWs and doubt cases receive two doses of the MMR vaccine. However, a small percentage of the fully immunized will remain unprotected against wild viruses. Moreover, protective levels of antibodies induced by the vaccine have been shown to decline over time, but a formal recommendation regarding the testing of immunized HCWs for the persistence of IgG against rubella is lacking. METHODS: The aim of this study was to evaluate the long-term immunogenicity conferred by rubella vaccination and the effectiveness of a strategy for the management of immunized individuals in whom IgG against rubella could not be demonstrated (non-responders). The study enrolled students and medical residents who attended the Hygiene Department of Bari Policlinico University Hospital for biological risk assessment (April 2014 to June 2018). RESULTS: Two thousand students and residents with documented immunization (≥2 doses of rubella or MMR vaccine) were tested. In 181 (9%), IgG against rubella was not detectable. The seronegative rate was higher among participants vaccinated at age < 2 years (89.6%) and lower among those immunized at age ≥ 2 years (93.6%; p < 0.0001). The administration of a single MMR booster dose resulted in a seroconversion rate of 98% in the seronegative group. The seroconversion rate after a second booster dose was 100%. No serious adverse events in the re-immunized were recorded. CONCLUSIONS: An important proportion of individuals immunized for rubella or MMR do not have a protective titer for the disease(s). Our management strategy (booster followed by re-test and, for those who are still negative, a second booster and re-test) is consistent with the goal of achieving immunological memory.

Policies for the immunization against serogroup B meningococcus for adolescents immunized during the first two years of life: A mini review.

Two vaccines are available to prevent serogroup B meningococcal disease, i.e. the four-component meningococcal serogroup B vaccine (4CMenB) and the bivalent-factor-H-binding-protein meningococcal serogroup B vaccine (MenB-fHbp). Currently, 4CMenB is offered as part of routine infant immunization schedules. Available immunogenicity data showed a progressive decline in protective serum bactericidal antibodies (SBA) titers, with a re-enhancement following a booster dose during infancy. Responses did not seem to be long-lasting and vaccinated individuals might be at risk of meningococcal diseases during adolescence. Only one study evaluated the possibility to administer a single booster dose to immunocompetent adolescents who received a primary series during infancy. Despite a high proportion of enrollees achieving protective SBA levels 28 days post-booster, titers tended to decrease 1 year after. Immunocompetent adolescents who received a primary series and a booster during the first two years of life might rather benefit from re-vaccination against MenB; current evidence does not support the possibility of a booster.

Efficacy of vaccination during pregnancy in reducing the risk of SARS-CoV-2 infection in infants younger than 12 months. Puglia (Italy), 2021-23.

This retrospective cohort study evaluated the effectiveness of maternal vaccination against COVID-19 in reducing the risk of SARS-CoV-2 infection in infants younger than 12 months. The study, conducted at the "Policlinico" University Hospital of Bari, included 3346 newborns and their mothers. The study explored the degree of protection offered by maternal vaccination depending on the timing, type, and trimester of vaccination, also taking into account the mother's history of infection. We compared the incidence rate of infection between children of vaccinated and unvaccinated mothers; the values were 10.2% and 18.1%, respectively, and the difference was statistically significant. The overall effectiveness of the vaccine against the infection was 45%. Further analysis revealed increasing efficacy as the doses of vaccine administered to the mother increased and in case of a previous history of maternal infection. Dual immune stimulation (vaccination and natural infection) was 83% effective in preventing infection among newborns. The multivariable models confirmed the protective effect of vaccination with all types of vaccines used. The analysis of infection's incidence in newborns revealed an interesting temporal trend, with increasing incidence with time, suggesting a possible correlation with the persistence of maternal antibodies or with the gradual weaning. The results on the protective capacity of vaccines are in line with the global literature. Strengths of study include sample size, robust methodology, and multivariate analyses. Institutions could intensify awareness campaigns to encourage both pregnant women and all those who would like to become pregnant to receive SARS-CoV-2 vaccination.

Active offer of Tdap vaccination in a cohort of healthcare workers of Maternal and Neonatal Department: Data from a large hospital in Southern Italy.

Pertussis is a vaccine-preventable respiratory disease. Pertussis vaccination is currently mandatory for all children in Italy, and is administered in three doses at the beginning of the third, fifth, and twelfth month of life, respectively. Booster doses are also recommended at five-six years, at eleven-twelve years, and then once every ten years. Healthcare workers (HCWs) are a high-risk population for pertussis. Strategies to increase HCWs' compliance to this vaccination have not been investigated in depth. Our study investigates the determinants of acceptance of a "soft nudge" vaccination campaign in a large hospital in Apulia (Southern Italy). HCWs from the Gynaecology and Neonatology Units of Bari's Policlinico General Hospital were screened in June 2023 for pertussis vaccination. Non-vaccinated subjects were offered a vaccination appointment. Vaccination determinants were studied, and a logistic regression model was built to identify determinants that significantly influence vaccination acceptance. At the time of screening, only 31.34% of target HCWs (68/217) had already been vaccinated. After the active call intervention, vaccine coverage rose to 70.00% (152/217). Significantly higher coverage was found in the Neonatology Unit (30/43, 69.77%) than in the Gynaecology unit (54/106, 50.94%) (Chi2: 4.41; p-value: 0.036). A logistic regression model confirmed a higher compliance to vaccination in HCWs staffed in the Neonatology Unit (Chi2: 2.08; 95%CI: 1.04 - 4.73; p-value: 0.038). Our intervention increased vaccination coverage in a high-risk cohort. The solicitation was effective, as communication with a trained specialist might have improved the subjects' perception of vaccination and individual risk of contagion and transmission to others. A synergistic approach, mixing active call with a vaccination mandate, might have greater effectiveness.

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.

Increasing vaccination coverage among healthcare workers: Active call and mandatory laws. Data from a large general hospital in Southern Italy.

Influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are respiratory pathogens which significantly impact healthcare systems. Seasonal vaccination is recommended for all healthcare workers (HCWs) to reduce the risk for both operators and patients. Puglia, a region in Southern Italy, has been enforcing since 2018 a law mandating influenza vaccination in healthcare workers. However, vaccination coverages for this category have always been suboptimal. Our study tests the effectiveness of an active recall intervention on vaccination coverage for influenza and SARS-CoV-2 in the HCWs of a large Apulian hospital (Southern Italy). During the 2023-2024 influenza vaccination season, unvaccinated HCWs of Bari's Policlinico General Hospital were contacted. The e-mail reminded them of a regional law mandating influenza vaccination to all HCWs and offered an appointment for vaccination. SARS-CoV-2 vaccination was also offered. In 2022-2023, 43.16 % of HCWs were vaccinated against influenza and 21.87 % against SARS-CoV-2. Coverage changed during the 2023-2024 season to 54.11 % and 13.58 %, respectively. A regression model showed that vaccination uptake's increase was associated with the e-mail reception and with the operator being a physician vs. non-medical personnel. On the contrary, subjects who received the e-mail did not show an increased SARS-CoV-2 vaccination uptake, which was on the contrary influenced by the worker's age, sex, job title, and area of risk. Our soft-mandate intervention was effective in increasing vaccination uptake by HCWs. Communication with a trained specialist was probably useful, and the possibility to access vaccination services with dedicated appointments increased convenience. Mandatory vaccination policies and active recall seem to synergically impact vaccination uptake.

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.