Adherence to Vaccination Policy among Public Health Professionals: Results of a National Survey in Italy

A comparative analysis of knowledge, attitude, and practice (KAP) towards influenza and influenza vaccination among healthcare workers in Kyrgyzstan prior to and during the COVID-19 pandemic

INTRODUCTION

Influenza, a globally significant respiratory illness with pandemic potential, affects around 1 billion individuals annually, leading to increased risk for severe illness and mortality. Despite recommendations from the WHO Strategic Advisory Group of Experts on Immunization (SAGE) and MoH prioritization, influenza vaccination coverage rate among HCWs in Kyrgyzstan remains low, ranging between 16 % and 46 % over the past five years. Understanding the Knowledge, Attitudes, and Practices (KAP) dynamics of HCWs regarding influenza vaccinations, both before and during the COVID-19 pandemic is crucial for refining national strategies and institutional approaches to enhance vaccination coverage rates in this important risk group.

METHOD

This study employed cross sectional investigations aimed at assessing KAPs among HCWs regarding influenza disease and vaccination. Conducted prior to and during the initial phase of the COVID-19 pandemic, the project involved 2400 participants from diverse medical disciplines. EPI Info was utilized to run biostatistical analyses, with descriptive and logistic regression models, to elucidate the dynamics of KAP over time.

RESULTS

The findings indicate that HCWs with over 5 years of experience were more likely to get vaccinated or recommend it to patients (p = 0.000). Low confidence in vaccine effectiveness influenced on recommendations of influenza vaccination in pre-pandemic time, where insufficient (95 %CI 0.08-0.6; p = 0.003) or uncertain assurance in vaccine effectiveness (95 %CI 0.007-0.18; p = 0.000) was a barrier for vaccine promotion during the pandemic. The study underscores to consider mandatory influenza vaccination for HCWs which may impact on likelihood of flu vaccination (p = 0.001). Priority groups for influenza vaccination shifted during the COVID-19 period, emphasizing older adults, individuals with existing conditions, and HCWs, compared to the pre-pandemic focus on HCWs, children, and patients with pre-existing conditions.

CONCLUSION

Our investigation provides valuable insights into HCWs KAP concerning influenza vaccination in Kyrgyzstan, highlighting the need for targeted interventions addressing factors influencing vaccine acceptance. The study suggests policy implications, advocating for the revision of national strategies to strengthen capacity building for medical staff.

Attitudes and practices to adult vaccination among physicians before and after COVID-19 pandemic in the United Arab Emirates

Introduction

Vaccination remains underutilised worldwide with low vaccine uptake rates across the board with many adults remaining unprotected. Across the Arab world, attitudes towards vaccines vary but high rates of vaccine hesitancy have been found. This study aims to explore the adult vaccination attitudes and practices by physicians in the UAE, both before and after the introduction of the COVID-19 vaccines.

Methodology

This cross-sectional, descriptive study used convenience and snowball sampling to collect comprehensive data from UAE physicians. A self-administered questionnaire was distributed in two stages: the first (pre-COVID-19 vaccines) between the months of June and October 2020 and the second between the months of November 2022 and March 2023.

Results

1000 responses, 500 from each time period, were collected. Nearly a third were family physicians or internists with more than 70% of the physicians working in governmental hospitals. 95% agreed that vaccines are safe in both cohorts but 74.4% reported not having enough time to advise about vaccines. 80.8% of physicians in the 2022 cohort reported safety concerns as the most common reason for patients to refuse vaccines. The most recommended vaccines were influenza (68.6%), Hepatitis B (66.0%) and HPV (61.4%), with pneumococcal coming in close at 57.8%. Family medicine physicians showed the highest utilisation of preventive practices across both cohorts. Nearly half of all family medicine physicians did not regularly evaluate both the influenza and general immunisation status of their patients. 54.6% of physicians reported having patients with VPDs in the last five years (not including COVID-19) in 2022.

Conclusion

Physicians have overly positive attitudes, but their practices reflect a more superficial appreciation of vaccines and lack of initiative. Physicians need to adopt a pro-vaccine stance, armed with the proper tools and the right mentality and beliefs.

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.

Influenza vaccination landscape in Italy: A comprehensive study through the OBVIOUS project lens

Influenza annually claims an estimated 8,000 lives in Italy. Despite no-cost vaccinations for high-risk groups, hesitancy persists. This study aims to pinpoint social and behavioral vaccination determinants, forming strategies to bolster vaccine uptake. From April 11 to May 29, 2022, we surveyed a demographic-stratified sample of 10,000 Italian adults, employing the WHO's Behavioral and Social Drivers of Vaccination (BesD) framework. Of those, 4,613 (46.1%) were eligible for the influenza vaccine and included in the analysis. Roughly a third remained unvaccinated and unwilling. Central Italy showed the highest resistance, with significant percentages of seniors and professionals like teachers, law enforcement, and healthcare workers expressing noncompliance. A lack of awareness of being in a target group correlated significantly with vaccine refusal or delayed acceptance. Other refusal factors included female gender, being aged 45-54, rural residency, absence of higher education, perceived vaccine unsafety, and having vaccine-opposed acquaintances. Thus, addressing these perceptions and enhancing awareness can potentially increase vaccination rates and lessen disease impact.

Knowledge and attitude factors associated with the prevalence of Tdap (tetanus, diphtheria, and acellular pertussis) booster vaccination in healthcare workers in a large academic hospital in Southern Italy in 2022: a cross-sectional study

Introduction

In Europe, there is still suboptimal tetanus, diphtheria, and acellular pertussis (Tdap) booster coverage. This study aimed to assess coverage status, knowledge, and attitude on Tdap vaccination in healthcare workers (HcWs) of the University Hospital "Federico II" in Naples, Southern Italy, in 2022, to improve current vaccination strategies.

Methods

A cross-sectional study was conducted using a validated anonymous questionnaire. Knowledge and attitude were measured as scores. Multivariable logistic and linear regression models were employed to identify correlates of Tdap booster and knowledge and attitude toward the vaccination, as appropriate. Models were controlled for age, sex, profession, department, and job seniority.

Results

A total of 206 questionnaires were administered among HcWs, and 143 (69.4%) were medical doctors. In total, 71 (34.47%) HcWs received the Tdap booster. Those who have worked 5-9 years at the hospital had a 78% lower likelihood of being vaccinated with the Tdap booster (5-9 years-OR: 0.22, CI: 0.06 | 0.85) as compared with newly hired HcWs. No differences in the average knowledge score were found. Other healthcare workers had a lower attitude as compared to medical doctors (Other-Coef. -2.15; CI: -4.14 | -0.15) and, as compared with those who worked in a clinical department, those who worked in a diagnostic-therapeutic department or medical management had 3.1 and 2.0 lower attitude scores, on average, respectively (diagnostic-therapeutic-Coef. -3.12, CI: -5.13 | -1.12; public health-Coef. -1.98, CI: -3.41 | -0.56).

Discussion

The study findings support the necessity to implement public health strategies and improve knowledge and attitude toward vaccinations and specifically highlight the importance of Tdap booster every 10 years as a prevention tool to protect high-risk populations.

Determinants of Acceptance of COVID-19 Vaccination in Healthcare and Public Health Professionals: A Review

Vaccinations of healthcare workers (HCWs) aim to directly protect them from occupational diseases, and indirectly protect their patients and communities. However, studies increasingly highlight that HCWs can be vaccine hesitant. This review aims to analyze HCWs' and public health professionals' sentiments toward COVID-19 (Coronavirus Disease 2019) vaccination and determinants across different countries. A search strategy was conducted in PubMed using keywords such as "COVID-19", "sentiment/acceptance", "healthcare workers", "vaccine hesitancy", and "influenza". A total of 56 articles were selected for in-depth analyses. The highest COVID-19 vaccination uptake was found in an Italian study (98.9%), and the lowest in Cyprus (30%). Older age, male gender, the medical profession, higher education level, presence of comorbidities, and previous influenza vaccination were associated with vaccine acceptance. Factors for low acceptance were perceived side effects of the vaccine, perceived lack of effectiveness and efficacy, and lack of information and knowledge. Factors for acceptance were knowledge, confidence in the vaccine, government, and health authorities, and increased perception of fear and susceptibility. All studies focused on healthcare providers; no studies focusing on public health professionals' sentiments could be found, indicating a gap in research that needs to be addressed. Interventions must be implemented with vaccination campaigns to improve COVID-19 vaccine acceptance.

Analysis of Knowledge, Attitudes and Behaviours of Health Care Workers towards Vaccine-Preventable Diseases and Recommended Vaccinations: An Observational Study in a Teaching Hospital

Background: Recommended vaccinations are the cheapest and most effective measure to reduce the risk of transmission and related complications, especially in high-risk healthcare settings. This study aimed to evaluate the knowledge, attitudes and behaviours of HCWs in relation to national recommendations. Methods: A transversal study was conducted through administration of a questionnaire by personal interview. The following care units were involved: Paediatric, Neonatal, Cardiac Surgery and General Intensive Care Units and Infectious Diseases Unit. Results: The study sample comprised 308 HCWs. Half the sample were aware of the vaccination recommendations, with occupation and age found to be predictive factors (OR = 9.38, 95%CI: 2.07−42.41; OR = 0.36, 95%CI: 0.22−0.60). A higher percentage defined the diseases as a risk for their patients’ health, although this perception was lower in the over-40 age group. In several cases, there were statistically significant differences between the care units (p < 0.001). Around three-quarters of the sample agreed that vaccination should be mandatory; willingness to undergo a future booster vaccination was statistically correlated with the variables of age and care unit (p < 0.001, p = 0.03). Conclusion: The protection of health in the workplace can be achieved through some strategic actions, such as the implementation of educational strategies, and protocols for the monitoring of immunocompetence and the improvement of vaccination.

Factors influencing healthcare professionals' confidence in vaccination in Europe: a literature review

Health-care professionals (HCPs) have a fundamental role in vaccination, their own beliefs and attitudes affecting both their uptake and recommendation of vaccines. This literature review (n = 89) summarises evidence on HCPs’ perceptions of the risks and benefits of vaccination, trust, and perceptions of mandatory vaccination in Europe. HCPs across studies believed that vaccination is important to protect themselves and their patients. However, beliefs that some diseases such as influenza are less risky were reported by some HCPs as a reason for not getting vaccinated. Concerns about both short- and long-term side effects were identified among HCPs in most studies, such as those affecting the immune or neurological system. Mistrust toward health authorities and pharmaceutical industry was reported in some studies. The question of mandatory vaccination revealed mixed opinions, with some favoring self-determination and others viewing vaccination as a duty. This review highlights key factors influencing HCPs’ confidence in vaccination in Europe.

How do Vaccinators Experience the Pandemic? Lifestyle Behaviors in a Sample of Italian Public Health Workers during the COVID-19 Era

Public health workers (PHWs) have experienced substantial workload changes because of their role in managing measures to limit the spread of COVID-19. The study’s aim was to assess lifestyle changes in Italian PHWs during the pandemic. PHWs attending an annual meeting completed an anonymous questionnaire assessing their sociodemographic and behavioral characteristics and lifestyle changes during the pandemic. A total of 1000 questionnaires were completed. Most participants (63.5% women, mean age 40 ± 13.1 years) were of normal weight (61.5%), non-smokers (81.9%), had a total screen time of ≥5 h/day (83.1%), and slept at least 6 h/night (88.7%). Approximately one-third consumed sweet foods every day (30%) and did not engage in physical activity (34.6%). Current sweet food consumption, physical activity, and sleep were associated with changes in these behaviors in the last 2 years (Tau-b = 0.155; Tau-b = −0.175; Tau-b = −0.276, respectively, p < 0.001). An increase in remote working was associated with worse sleep (odds ratio (OR) 2.065, 95% confidence interval (CI) 1.482–2.877) and diet (OR 1.982, 95% CI 1.385–2.838), and increased tablet/PC use (OR 3.314, 95% CI 2.358–4.656). Health promotion measures are needed to support the adoption of healthy lifestyles in this population during the current pandemic.

The impact of COVID-19 on hospital-based workers influenza vaccination uptake: A two-year retrospective cohort study

OBJECTIVES

This study aimed at exploring 2020/2021 and 2019/2020 seasonal influenza vaccine uptake among healthcare and non-healthcare workers, hereafter hospital-based workers (HBWs); examining attitudes and motivations for uptake in the 2020/2021 season; and exploring the amount, types, and sources of information used by HBWs.

METHODS

A retrospective cohort study. Socio-demographics, working profile, working area, and vaccination status data were collected. Motivations for vaccination uptake in the 2020/2021 season were also explored. Descriptive and inferential statistics were used.

RESULTS

Overall, uptake increased from 14.8% in 2019/2020 to 31.7% in 2020/2021. Male workers show greater vaccination uptake than their female counterparts (20.4% vs. 12.6% in 2019/2020, and 36.5% vs. 29.8% in 2020/2021). Uptake increased for healthcare assistants (+8.9%), administrative/managerial staff (+17%), nurses/midwives (+17.1%), non-medical graduate staff (+22.8%), and physicians (+33.2%), while it decreased slightly for resident physicians despite still being one of the most vaccinated categories (-4.6%). Main reasons for vaccination were the desire to protect patients (33.0%) and relatives (51.1%). Lastly, 60.8% of HBWs relied on institutional sources of information; the remainder relied on non-institutional sources including social media and chatting with colleagues.

CONCLUSIONS

Vaccination uptake increased in the 2020/21 season. Tailored educational interventions are required on the impact of influenza in care settings, vaccine efficacy, and vaccination safety. Investments in improving HBWs' reliance on institutional sources, and their ability to find them, are also needed.

The Reliability of Anamnestic Data in the Management of Clostridium Tetani Infection in Elderly

Background: Tetanus infection remains a significant complication of wounds. Because most tetanus treatment guidelines rely on anamnestic data collected directly from patients, the congruence between anamnesis and laboratory evidence must be verified, especially in the elderly population.

Aim: Assess, in both the geriatric population (>65) and the non-geriatric one, the reliability of anamnestic data for managing patients with tetanus-risk wounds, identified categories of populations most exposed to non-vaccination coverage, and assessed the agreement of the Tetanos Quick Stick (TQS) results with the therapy performed (administration of tetanus vaccine or immunoglobulin).

Methods: In this retrospective single-center observational study, patients were asked their immunization status against tetanus vaccination. The decision to administer a vaccine or immunoglobulin was therefore clinical and based on anamnestic criteria. The TQS test was then given to patients who were unaware of their immunity status. Patients who thought they knew it but were not sure were given the TQS test to determine whether the anamnestic collection was supported by the test. The TQS test results were compared with the anamnestic data.

Results: Most patients, geriatric and not geriatric, did not know their immune status. Among those who reported knowing their immune status, there was no agreement between the vaccine coverage declared by patients and the TQS test results (p < 0.001), mainly in geriatric patients but also in the control group. Elderly and women had significantly lower positive TQS test results (p < 0.001). There was a statistically significant discrepancy (p < 0.001) between the therapy based on anamnestic data and the TQS test results.

Conclusion: The reliability of anamnestic data for the management of patients with tetanus-risk wounds is low and decreases with age, becoming minimal in geriatric patients. Elderly and women are less likely to have an effective vaccination status against tetanus.

Attitude Towards COVID-19 Vaccination Among Healthcare Workers: A Systematic Review

INTRODUCTION

Availability and accessibility of a safe COVID-19 vaccine do not necessarily guarantee an effective means to mitigate the pandemic. However, the fragile hero's or health care worker's attitude toward the vaccine is of paramount importance to promote its acceptance. So, the current review aims to provide the latest assessment of healthcare workers' attitudes toward the COVID-19 vaccination and its contributing factor worldwide.

METHODS

Peer-reviewed surveys in English indexed via an electronic database in Google Scholar, Science Direct and PubMed were systematically searched. The review was carried out per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA-2009) and registered on PROSPERO (CRD42021265534).

RESULTS

Originally 8039 articles were searched from three databases PubMed, Science direct, and Google scholar. Finally, 24 studies met the inclusion criteria and made the root for the estimates of the attitude of COVID -19 vaccinations. In about two-thirds of the studies, respondents showed a positive attitude (≥50%) toward COVID-19 vaccination. However, in about one-quarter of the studies, a negative attitude (<50%) against vaccination was reported. Factors related to the attitude of healthcare workers toward COVID-19 vaccination include age, sex, profession, concerns about the safety of vaccines and fear of COVID-19, trust in the accuracy of the measures taken by the government, flu vaccination during the previous season, comorbid chronic illness, history of recommendation, and depression symptoms in the past week.

CONCLUSION

Although most studies report that healthcare workers have a positive attitude toward COVID-19 vaccination, quite a few surveys mention negative attitudes towards the use of vaccines, which may reflect missed opportunities or challenges for the international efforts aimed at mitigating the pandemic. Still, we need to continue to make more efforts to change the attitudes of the uncertain healthcare workers to increase the uptake of the vaccine and deal with the multi-faceted impact of infection.

Rotavirus Vaccination of Infants Delayed and Limited within the National Immunization Programme in the Netherlands: An Opportunity Lost

In this study, we estimated the benefits of rotavirus vaccination for infants had the rotavirus vaccine been introduced in the Netherlands as of its market authorization in 2006. An age-structured, deterministic cohort model was developed to simulate different birth cohorts over a period of 15 years from 2006 until 2021, comparing both universal and targeted high-risk group vaccination to no vaccination. Different scenarios for the duration of protection (5 or 7 years) and herd immunity (only for universal vaccination) were analyzed. All birth cohorts together included 2.6 million infants, of which 7.9% were high-risk individuals, and an additional 13.2 million children between 1-15 years born prior to the first cohort in 2006. The costs and health outcomes associated with rotavirus vaccination were calculated per model scenario and discounted at 4% and 1.5%, respectively. Our analysis reveals that, had rotavirus vaccination been implemented in 2006, it would have prevented 356,800 (51% decrease) and 32,200 (5% decrease) cases of rotavirus gastroenteritis after universal and targeted vaccination, respectively. Over the last 15 years, this would have led to significant avoided costs and quality-adjusted life year losses for either vaccination strategy with the most favorable outcomes for universal vaccination. Clearly, an opportunity has been lost.

Variables Influencing per Capita Production, Separate Collection, and Costs of Municipal Solid Waste in the Apulia Region (Italy): An Experience of Deep Learning

Municipal solid waste (MSW) must be managed to reduce its impact on environmental matrices and population health as much as possible. In particular, the variables that influence the production, separate waste collection, and costs of MSW must be understood. Although many studies have shown that such factors are specific to an area, the awareness of these factors has created opportunities to implement operations to enable more effective and efficient MSW management services, and to specifically respond to the variables that have the most impact. The deep learning approaches used in this study are effective in achieving this goal and can be used in any other territorial context to ensure that the organizations that deal with these issues are more aware and create useful plans to promote the circular economy. Our findings indicate the important influence of number of rooms in a residential buildings and construction years on MSW production, the combination of services such as municipal collection centers and door-to-door service for separate MSW collection and the characteristics of the residential buildings in the municipalities on MSW management costs.

Meningococcal Disease and Related Vaccinations: Knowledge, Attitudes, and Practices among Healthcare Workers Who Provide Care to Patients with Underlying High-Risk Medical Conditions

This cross-sectional study assessed knowledge, attitudes, and practices regarding meningococcal disease and related vaccinations among healthcare workers (HCWs) who provided care to patients with underlying high-risk medical conditions. A total of 411 HCWs returned the survey. Only 35% of the respondents had a good knowledge about the incidence and lethality of meningococcal disease, the most frequent serogroups in Italy and the diseases or conditions that expose patients to a high-risk of severe complications caused by meningococcal disease. Vaccination against meningococcal disease was perceived to be highly effective by 38.4% of participants, very safe by 36.2%, and 82% agreed or strongly agreed that HCWs should promote adherence to recommended vaccinations even in hesitant patients. Moreover, 34.1% recommended meningococcal vaccinations to all eligible patients and the results of the multivariate analysis showed that older HCWs, who work in pediatric/neonatal wards, have good knowledge about meningococcal vaccinations, have a favourable attitude towards vaccinations, and do not need additional information about meningococcal vaccinations, were more likely to recommend meningococcal vaccinations to all eligible patients. Interventions aimed at the enhancement of knowledge and awareness of HCWs who provide care to these patients on the benefits of meningococcal vaccinations are warranted.