Factors associated with poor adherence to MMR vaccination in parents who follow vaccination schedule

Measles Immunization Status of Health Care Workers: A Cross-Sectional Study Exploring Factors Associated with Lack of Immunization According to the Health Belief Model

Suboptimal levels of measles vaccination coverage make Italy a country where the circulation of the virus is still endemic. In the past decade, several nosocomial outbreaks of measles occurred in Italy that rapidly spread the infection among large numbers of hospitalized patients and susceptible healthcare workers (HCWs). A cross-sectional study was conducted at the University Hospital of Palermo (Italy) to estimate the rate of HCWs immunization and to investigate the factors associated with lack of immunization. The attitude to the immunization practice was evaluated by exploring the Health Belief Model. Overall, 118 HCWs were enrolled, with a mean age of 31 years and 59.3% male. About half of the sample (45.8%, n = 54) was found not to be immunized against measles. Multivariable analysis showed that the factors directly associated with the non-immunization status against measles were female sex (OR = 3.70, p = 0.056), being an HCW different from a physician (OR = 10.27, p = 0.015), having a high perception of barriers to vaccination (OR = 5.13, p = 0.047), not being immunized for other exanthematous diseases such as chickenpox (OR = 9.93, p = 0.003), mumps (OR = 33.64, p < 0.001) and rubella (OR = 10.12, p= 0.002). There is a need to contrast the low adherence of HCWs to measles vaccination by identifying effective strategies to increase immunization coverage and limiting the risk of further nosocomial measles outbreaks.

Cost-minimization analysis of DTaP-IPV-Hib combination vaccine in China: A nationwide cross-sectional study

Combination vaccines can reduce the vaccination visit, simplify the vaccination schedule and efficiently improve management. This study was primarily designed to evaluate the economic impact of integrating the diphtheria-tetanus-acellular pertussis inactivated poliomyelitis and Haemophilus influenzae type B (DTaP-IPV-Hib) combination vaccine into the China National Immunization Program. A cost-minimization analysis (CMA) compared the costs associated with direct medical, direct nonmedical, and indirect social costs in four schemes was conducted. A budgetary impact analysis assessed the alternative schemes' financial impact on the healthcare budget. Direct medical costs were extracted using a costing questionnaire and an observational time and motion chart. Direct nonmedical (cost for transportation) and indirect costs (loss of productivity) were derived from parents' questionnaires. Replacement of the current vaccination scheme with DTaP-IPV-Hib combination vaccine, resulted in net increases in direct medical costs of 77.64% for alternative scheme 1, 146.54% for alternative scheme 2, and 294.67% for alternative scheme 3, respectively. However, the direct nonmedical and indirect costs and the cost of the alternative schemes were 18.18%, 36.36%, and 63.64% lower than the current scheme for alternative scheme 1, alternative scheme 2, and alternative scheme 3, respectively. From the societal perspective, when compared with the current scheme, the budgetary impact of the three alternative schemes were +66 million Chinese Yuan (CNY) (4.81%), +103 million CNY (7.53%), and +305million CNY (22.35%), respectively. The CMA considered a broader perspective of social costs and indicated that the alternative schemes would result in an overall saving of parents' transportation and work loss costs to bring their children for vaccination, translating into a total cost saving of 18.18%, 36.36%, 63.64%, comparing to the current scheme. Thus, fully or partly using the DTaP-IPV-Hib combination vaccine is cost-saving in the context of China.

The Development and Preliminary Application of the Chinese Version of the COVID-19 Vaccine Literacy Scale

(1) Background: Vaccine literacy (VL) of the public is crucial to deal with anti-vaccination rhetoric. This study aims to (1) develop a Chinese COVID-19 Vaccine Literacy Scale and examine the factor structure and psychometric characteristics, and (2) explore the association between COVID-19 VL and sociodemographic characteristics and other variables; (2) Methods: An online cross-sectional survey was conducted among 362 Chinese residents from 23 May 2022 to 31 May 2022 using snowball sampling; (3) Results: Exploratory and confirmatory factor analysis indicated that the scale of 15 items, consisting of three factors, functional, interactive and critical vaccine literacy, explained 63.3% of the total variance. Cronbach's α coefficient was 0.885 for the overall scale: 0.838, 0.891, and 0.857 for three subscales, respectively. The results showed a medium level of vaccine literacy (M = 3.71, SD = 0.72) and significant differences among functional, interactive, and critical vaccine literacy (p < 0.001). The level of vaccine literacy grew with the level of education (p < 0.001) and age (p = 0.049). Men, participants who were single, or those living in rural areas had a lower level of vaccine literacy; (4) Conclusions: The Chinese COVID-19 VL Scale has adequate validity and reliability for assessing vaccine literacy among Chinese residents. A deep understanding of the factors that affect vaccine literacy is needed.

Factors related to parents’ adherence to childhood immunization

Background

Immunizations protect children from deadly infectious diseases. Yet, there is still insufficient understanding of the factors associated with parents’ non-adherence to immunizations in contexts outside of Western countries. The aim of this study is twofold: (a) to investigate non-adherence to immunizations for children aged 6 months to 6 years in Saudi Arabia based on the number of immunizations missing or delayed by more than one month; and (b) to examine the underlying factors that predict the extent of non-adherence based on the Health Belief Model framework.

Methods

A cross-sectional study was carried out in 22 randomly selected primary health care centers. Structured interviews were also conducted to collect data using the modified Health Belief Model questionnaire. Multiple regression analysis was used to assess the predictors of the extent of non-adherence.

Results

Based on data from 220 participants, 51.8% of parents did not adhere with childhood immunizations. There was no significant relationship between parents’ sociodemographic characteristics and the extent of their hesitancy about children’s immunizations. The linear combination of perception of infectious disease severity, perception of their children’s susceptibility, perception of immunization benefits, perception of fewer barriers to obtaining immunizations, cues to action related to immunizations, and self-efficacy predicted the extent of non-adherence to immunizations (F (11.220) = 2.595, p < 0.001) and explained 12% of its variance. Yet, only perceived children’s susceptibility, perceived barriers, and self-efficacy independently predicted parents’ non-adherence.

Conclusion

Saudi Arabia’s high proportion of non-adherence to childhood immunizations should be addressed. For instance, a health education program could be developed to increase parents’ awareness that their children are susceptible to health risks. Paying a special attention to existing barriers in accessing and receiving the immunizations is crucial. In addition, building parents’ self-efficacy, which is confident in making healthy decisions, such as keeping their children’s immunizations up to date, is important.

Childhood immunisation timeliness and vaccine confidence by health information source, maternal, socioeconomic, and geographic characteristics in Albania

Background

Albania is facing decreasing childhood immunisation coverage and delay in timeliness of vaccination despite a growing economy and universal health insurance. Our aim is to estimate childhood immunisation timeliness and vaccine confidence associated with health information source, maternal, socioeconomic, and geographic characteristics in Albania.

Methods

We used the 2017–2018 Albania Demographic and Health Survey to analyse childhood immunisation timeliness and vaccine confidence among 2113 and 1795 mothers of under-5-year-old children respectively using simple and multivariable logistic regression.

Results

Among mothers of under-5-year-old children in Albania, 78.1% [95% CI: 74.3, 81.5] never postponed or rejected childhood vaccines. Immunisation delay was reported by 21.3% [18.0, 25.1] of mothers, but a majority (67.0%) were caused by the infant’s sickness at the time of vaccination, while a minority (6.1%) due to mothers’ concerns about vaccine safety and side effects. Vaccine confidence was high among the mothers at 92.9% [91.0, 94.4] with similar geographical patterns to immunisation timeliness. Among 1.3% of mothers who ever refused vaccination of their children, the main concerns were about vaccine safety (47.8%) and side effects (23.1%). With respect to childhood immunisation timeliness, after controlling for other background characteristics, mothers whose main health information source was the Internet/social media had 34% (adjusted odds-ratio AOR = 0.66 [0.47, 0.94], p = 0.020) lower odds in comparison to other sources, working mothers had 35% (AOR = 0.65 [0.47, 0.91], p = 0.013) lower odds in comparison to non-working mothers, mothers with no education had 86% (AOR = 0.14 [0.03, 0.67], p = 0.014) lower odds compared to those who completed higher education, and mothers living in AL02-Qender and AL03-Jug regions had 62% (AOR = 0.38 [0.23, 0.63], p < 0.0001) and 64% (AOR = 0.36 [0.24, 0.53], p < 0.0001) lower odds respectively in comparison to those residing in AL01-Veri region (p < 0.0001).   With respect to vaccine confidence, mothers whose main health information source was the Internet/social media had 56% (AOR = 0.44 [0.27, 0.73], p = 0.002) lower odds in comparison to other sources, single mothers had 92% (AOR = 0.08 [0.01, 0.65], p = 0.019) lower odds compared to those married/living with a partner, mothers of specific ethnicites (like Roma) had 61% (AOR = 0.39 [0.15, 0.97], p = 0.042) lower odds in comparison to mothers of Albanian ethnicity, and mothers living in AL03-Jug region had 67% (AOR = 0.33 [0.19, 0.59], p ≤ 0.0001) lower odds compared to mothers residing in AL01-Veri region.

Conclusions

Reinforcement of scientific evidence-based online communication about childhood immunisation in combination with tracking and analysis of vaccine hesitancy sentiment and anti-vaccination movements on the Internet/social media would be beneficial in improving immunisation timeliness and vaccine confidence in Albania. Since parents tend to search online for information that would confirm their original beliefs, traditional ways of promoting vaccination by healthcare professionals who enjoy confidence as trusted sources of health information should be sustained and strengthened to target the inequities in childhood immunisation timelines and vaccine confidence in Albania.

Differential Demographic and Clinical Characteristics between MMR Vaccinated and Unvaccinated Children in South Korea: A Nationwide Study

In the context of recent measles outbreaks, substantial factors associated with measles-mumps-rubella (MMR) unvaccination need to be clarified. This study aimed to identify differential demographic and clinical characteristics between MMR vaccinated and unvaccinated groups. We used a large-linked database to identify children born between 2008 and 2016 by combining data from the Korea Immunization Registry Information System and National Health Information database. The MMR vaccination status was ascertained up to the age of 2 to define MMR vaccinated and unvaccinated groups. We conducted a multivariate logistic regression to estimate odds ratios (ORs) with 95% confidence intervals (CIs) to identify factors associated with MMR unvaccination. Of 3,973,253 children, 75,674 (1.9%) did not receive the MMR vaccine. Compared with the MMR vaccinated group, the underutilization of healthcare resources was more notable in the MMR unvaccinated group (number of outpatient visits (5.73 ± 12.1 vs. 25.8 ± 17.06); days hospitalized (1.69 ± 14.5 vs. 2.32 ± 6.90)). Children were less likely to receive the MMR vaccine if they were born with congenital anomaly (OR 2.12; 95% CI 1.90–2.36), were never admitted to an intensive care unit (1.88; 1.78–1.98), or never visited an emergency room (3.57; 3.53–3.72). There were substantial factors associated with MMR unvaccination, underscoring a need to optimize targeted interventions tailored to the subset of children in South Korea.

Timeliness of Childhood Vaccination Coverage: the Growing Up in Singapore Towards Healthy Outcomes Study

Studies investigating timeliness for childhood vaccination are limited especially in Asia. We examined the timeliness of vaccine administration and associated factors among infant and young children in Singapore. A total of 782 children born between November 2009 and July 2011 from a prospective cohort in Singapore were studied. Vaccination records from birth to 24 months of age were obtained from the National Immunization Registry of Singapore. Multivariable logistic regression models were performed. By 2 years of age, 92.8% of children in our cohort experienced a delay in receiving 1 or more vaccine doses according to the recommended national immunization schedule. When vaccinations were reviewed by series for each vaccine, 15.6% received all vaccine series outside the recommended age ranges. Factors associated with receiving vaccination series outside the recommended ages included maternal aged ≤ 35 years (OR 2.00; 95% CI 1.09, 3.66), Malay (1.71; 1.01, 2.89) or Indian ethnicity (2.06; 1.19, 3.59), low monthly household income (1.91; 1.14, 3.18), having at least four children (3.46; 1.62, 7.38) and private (3.42; 1.80, 6.48) and multiple vaccination providers (3.91; 1.23, 12.48). These findings show an unacceptably high proportion of children experienced a delay in the receipt of their vaccinations. The identification of several demographic, socioeconomic, health-seeking behavioural and vaccine provider factors provides opportunities for targeted interventions to enhance the timeliness of childhood vaccination in Singapore.

Resurgence of Measles in Europe: A Systematic Review on Parental Attitudes and Beliefs of Measles Vaccine

BACKGROUND AND OBJECTIVES

Europe has experienced a major resurgence of measles in recent years, despite the availability and free access to a safe, effective, and affordable vaccination measles, mumps and rubella vaccine (MMR). The main driver for this is suboptimal vaccine coverage. The three objectives of this study are to synthesize and critically assess parental attitudes and beliefs toward MMR uptake, to develop strategies and policy recommendations to effectively improve MMR vaccine uptake accordingly, and ultimately to identify areas for further research.

METHODS

A systematic review was conducted using primary studies from PubMed, Medline, Embase, and Scopus published between 2011 and April 2019. Inclusion criteria comprised primary studies in English conducted in Europe and studying parental attitudes and behavior regarding MMR uptake. Data were extracted using an inductive grounded theory approach.

RESULTS

In all, 20 high-quality studies were identified. Vaccine hesitancy or refusal were mainly due to concerns about vaccine safety, effectiveness, perception of measles risk and burden, mistrust in experts, and accessibility. Factors for MMR uptake included a sense of responsibility toward child and community health, peer judgement, trust in experts and vaccine, and measles severity. Anthroposophical and Gypsy, Roma, and Traveler populations presented unique barriers such as accessibility.

CONCLUSION

A multi-interventional, evidence-based approach is vital to improve confidence, competence, and convenience of measles vaccination uptake. Healthcare professionals need an understanding of individual contextual attitudes and barriers to MMR uptake to tailor effective communication. Effective surveillance is needed to identify under-vaccinated populations for vaccination outreach programs to improve accessibility and uptake.

Resources for assessing parents' vaccine hesitancy: a systematic review of the literature

The concept of Vaccine Hesitancy has begun to appear in the scientific landscape, referring to the reluctance of a growing proportion of people to accept the vaccination offer. A variety of factors were identified as being associated with vaccine hesitancy but there was no universal algorithm and currently there aren’t any established metrics to assess either the presence or impact of vaccine hesitancy. The aim of this study was to systematically review the published questionnaires evaluating parental vaccine hesitancy, to highlight the differences among these surveys and offer a general overview on this matter. This study offers a deeper perspective on the available questionnaires, helping future researches to identify the most suitable one according to their own aim and study setting.

The relationship between parental source of information and knowledge about measles / measles vaccine and vaccine hesitancy

OBJECTIVES

Based on the hypothesis that sources of information might affect knowledge and vaccine acceptance, our objectives were to study parental characteristics and sources of information regarding measles/measles vaccine, its relationship to correct knowledge and to administration of the measles vaccine.

BACKGROUND

Although measles eradication is potentially achievable, in 2018-2019 a worldwide resurgence of measles and measles-caused deaths occurred. The main driver was incomplete or no vaccination, designated as vaccine hesitancy (VH).

METHODS

A cross-sectional survey of 399 individuals dispersed all over the country was conducted. Research assistants interviewed parents with a 20-question survey which was previously validated. The questionnaire included four sections: demographics, major sources of information on measles/measles vaccine, knowledge about measles/measles vaccine, and status of child's vaccination. Univariate and multivariate analyses explored associations between correct knowledge and VH.

RESULTS

The majority of respondents were between the ages of 25-39 (62%). Of these, 309 (77%) vaccinated their children against measles on time, 32 (8%) vaccinations were incomplete, and 58 (15%) did not vaccinate, for a total VH of 23%. Parents < 30 years-old and those with a single-child vaccinated less frequently (p < 0.001 and p = 0.002, respectively). Internet and social-media were the major source of information for 32% regarding measles/measles vaccine and for 49% regarding the measles outbreak; both sources were negatively associated with correct knowledge (p < 0.001). In the multivariate analysis, knowledge was independently associated with timely vaccine administration (p < 0.001) and internet or social-media as sources with higher VH (OR 2.52, 95%CI 1.18-5.37 and OR 2.44, 95%CI 1.01-5.91, respectively).

CONCLUSIONS

Social-media and internet are a common source of information on measles/measles vaccine (probably on other vaccines as well), and often associated with incorrect knowledge, which relates significantly to VH. Healthcare professionals should be aware of this prevailing behavior and respond accordingly in these platforms, with the aid of experts in social-networking.

Knowledge and attitudes of parents after the implementation of mandatory vaccination in kindergartens of Palermo, Italy

Background and aim of the work:

Even though vaccination is easy to access in Europe, it has been facing several outbreaks caused by vaccine preventable diseases. Trying to balance the right to health of the community with individual self-determination, in Italy was mandate vaccination for ten vaccine preventable diseases in 2017. The project “Sportello Vaccinale” provided a counseling service to parents in kindergarten of Palermo. The main objective of the study was to investigate knowledge and compliance on vaccination by children’s parents after the implementation of mandatory vaccination.

Methods:

A cross sectional study was conducted among parents accessing to the “Sportello Vaccinale” using a questionnaire. The questionnaire consisted of 34 items divided into three sections: socio-demographic data; knowledge and attitude on mandatory vaccination using Health Belief Model (HBM); Health Literacy (HL) level.

Results:

A total of 95 questionnaires were garnered in the kindergartens from respondents with a mean age of 36 (±SD=6) years. The respondents who delayed hexavalent or Measles, Mumps, Rubella and Varicella (MMRV) vaccinations were 8 (8%) and the more frequent cause was fear of adverse reaction (87%). The sample had more often high level of health literacy (37%), and 55% had higher HBM score. The factor significantly associated with higher HBM score was the age of respondents (OR= 1.14, p=0.006) after controlling for other variables.

Conclusions:

Consent to vaccination practice was widely represented, but the results of the study highlighted the need for parents to have more information and more time devoted to the practice of vaccination counseling. Implementing counseling activities at school or at the vaccination service, could support an aware decision process of the parents on vaccination topic.

Health Information Sources, Perceived Vaccination Benefits, and Maintenance of Childhood Vaccination Schedules

Parental concerns over the safety or necessity of childhood vaccination have increased over the past decades. At the same time, there has been a proliferation of vaccine-related information available through a range of health information sources. This study investigates the associations between evaluations of health information sources, parental perceptions of childhood vaccination benefits, and the maintenance of vaccination schedules for their children. Specifically, this study aims to (a) incorporate social media into the battery of health information sources and (b) differentiate households with a childhood autism diagnosis and those without, given unsubstantiated but persistent concerns about vaccine safety and autism. Analyzing a sample of U.S. households, a total of 4,174 parents who have at least one child under the age of 18 were analyzed, including 138 of parents of households with a childhood autism diagnosis. Results show that the more the parents value interpersonal communication and magazines as sources of health information, the more they perceive vaccination benefits, and the more the value they put on television, the better they keep vaccination schedules up-to-date for their children. On the other hand, social media are negatively associated with their perceptions of vaccination benefits. Although parents of children diagnosed with autism are less likely to perceive vaccination benefits, no interaction effects with evaluations of health information sources are found on parental perceptions of vaccination benefits or maintenance of schedules.

Measles-Related Hospitalizations in Italy, 2004-2016: The Importance of High Vaccination Coverage

BACKGROUND

Measles is a highly contagious human infectious disease. It can lead to serious complications and often requires hospitalization. In Italy, as in other European countries, the goal of measles elimination in 2015 failed. To reach this target, identifying susceptible individuals, closing any immunity gaps and reaching adequate vaccination coverage is necessary.

OBJECTIVE

To contribute to these purposes, a retrospective observational study on measles-related hospitalization between 2004 and 2016 in Italy was conducted, using the national hospital discharge database as informational flow.

METHODS

Admission frequencies and hospitalization rates were compared between regions with low (&lt;90%) and high (≥90%) vaccination coverage for measles at age 24 months. Categorical variables were analyzed using the χ2 test or the χ2 test for trend for ordinal variables; t test was performed to verify the significance when annual average hospitalization rates were compared. Trends of vaccination coverage and hospitalization rates were analyzed using the slope of the regression line.

FINDINGS

During the study period, 9,546 measles-related hospitalizations were collected in Italy, with an average annual number equal to 734. The overall measles hospitalization rates increased from 0.21 × 100,000 persons in 2004 to 0.82 × 100,000 in 2016 (β = 0.04; p = 0.689). A shift of mean age (from 1-17 years to 18-44 years) of measles-related hospitalizations was shown. A number of admissions for the low vaccination coverage group about twice as much as recorded for the other regional group was shown (6,344 vs 3,202). The involvement of 18-44 age class in the high vaccination coverage group was 14% higher compared with the low vaccination coverage group, in which, however, the 1-17 age class presented a 16% higher frequency.

CONCLUSIONS

These findings confirmed that large measles epidemics continue to occur in Italy, although with regional differences related to different rates of measles immunization. Vaccination coverage &gt;90% led to a halving of measles hospitalizations, but it is insufficient for the elimination: ≥95% coverage continues to be the target to be reached.

Vaccine Hesitancy and Online Information: The Influence of Digital Networks

Aims. This article analyzes the digital childhood vaccination information network for vaccine-hesitant parents. The goal of this study was to explore the structure and influence of vaccine-hesitant content online by generating a database and network analysis of vaccine-relevant content. Method. We used Media Cloud, a searchable big-data platform of over 550 million stories from 50,000 media sources, for quantitative and qualitative study of an online media sample based on keyword selection. We generated a hyperlink network map and measured indegree centrality of the sources and vaccine sentiment for a random sample of 450 stories. Results. 28,122 publications from 4,817 sources met inclusion criteria. Clustered communities formed based on shared hyperlinks; communities tended to link within, not among, each other. The plurality of information was provaccine (46.44%, 95% confidence interval [39.86%, 53.20%]). The most influential sources were in the health community (National Institutes of Health, Centers for Disease Control and Prevention) or mainstream media ( New York Times); some user-generated sources also had strong influence and were provaccine (Wikipedia). The vaccine-hesitant community rarely interacted with provaccine content and simultaneously used primary provaccine content within vaccine-hesitant narratives. Conclusion. The sentiment of the overall conversation was consistent with scientific evidence. These findings demonstrate an online environment where scientific evidence online drives vaccine information outside of the vaccine-hesitant community but is also prominently used and misused within the robust vaccine-hesitant community. Future communication efforts should take current context into account; more information may not prevent vaccine hesitancy.

Determinants of influenza vaccination among solid organ transplant recipients attending Sicilian reference center

Among solid organ transplant recipients, influenza infection is commonly associated with higher morbidity and mortality than immunocompetent hosts. Therefore, in these subjects influenza vaccination is of paramount importance. The main objective of the study was to assess compliance to vaccination and analyze factors associated with influenza vaccination of solid organ transplant recipients admitted to the Sicilian solid organ transplant Reference Center IRCCS-ISMETT in Palermo during 2014-2015 influenza season. Thirty one (37.8%) out of 82 solid organ transplant recipients were vaccinated against influenza. The main reason for vaccination refusal was fear of adverse reaction (n = 16, 31.4%), impaired health status (n = 14, 27.4%) and low vaccine efficacy (n = 10, 19.6%). Vaccinated solid organ transplant recipients compare with unvaccinated had smaller hospital admissions for infectious respiratory diseases (9.7% Vs 23.5%) during surveillance period. On multivariate analysis the factors positively associated with influenza vaccination were the advice of Reference Center physicians (OR 53.4, p < 0.001) and to perform vaccine against pneumococcus (OR 7.0, p = 0.016). This study showed that Reference Center physicians play a key role on vaccine communication and recommendation for patients at risk and it underlines the effectiveness of influenza vaccination in solid organ transplant recipients. However, it remains that, although physician advice resulted a strong determinant for vaccination, influenza vaccination coverage in this subset of population remains still unsatisfactory.

Knowledge attitude and practice toward pertussis vaccination during pregnancy among pregnant and postpartum Italian women

In Italy, no specific recommendation toward maternal pertussis immunization during pregnancy has been issued. However, vaccination during pregnancy will be likely integrated in the Italian immunization program in the future. In order to identify barriers to achieving a sufficient vaccination coverage during pregnancy, we investigated knowledge, attitude and practice toward pertussis vaccination during pregnancy through a web-based survey. A total of 343 Italian pregnant women (N = 164) and women in the postpartum period (N = 183) completed the online questionnaire. More than a half of the study population was uncertain regarding the benefits of the vaccination during pregnancy. Only 1.7% of women in the postpartum had received the vaccination during pregnancy, and 21% of pregnant women declared the intention to be vaccinated in pregnancy. Only 34% would accept the vaccination in the current or in a future pregnancy, if recommended by a physician, and a half would remain uncertain. Perceiving the vaccine as harmful for the fetus' development is associated to a decreased willingness to be vaccinated if recommended by a HCP, both in pregnant women (OR 0.25 p = 0.010 95% CI 0.09-0.72) and in women in the postpartum period (OR 0.32 p =  0.006 95% CI 0.15-0.72). Our study suggests that the vaccination recommendation by physicians might not be sufficient to adequately raise vaccination coverage against pertussis among Italian pregnant women. A combination of educational interventions and tailored communi-cation campaigns could be implemented to promote maternal immunization.

The effectiveness of measles-mumps-rubella (MMR) vaccination in the prevention of pediatric hospitalizations for targeted and untargeted infections: A retrospective cohort study

OBJECTIVES

To evaluate the effectiveness of the measles-mumps-rubella (MMR) vaccine in reducing hospitalizations for infectious disease, targeted and not targeted, as well as from respiratory diseases in children in Rome.

METHODS

The cohort was recomposed through record linkage of 2 archives (vaccination register and hospital discharge records.

RESULTS

The analysis included 11,004 children. 20.9% did not receive the MMR vaccination, 49% and 30.1% received one and 2 doses. There were no hospitalizations for rubella, 2 for mumps, and 12 for measles. The vaccine was highly protective against measles and mumps hospitalizations (HR = 0.10; 95% CI: 0.03.0.34). Regarding all infectious diseases there were 414 hospitalizations, and the vaccine was protective (HR = 0.29; 95% CI: 0.25 to 0.34). Concerning respiratory diseases, there were 809 admissions (7.4%), and the vaccine was highly protective (HR: 0.18; 95% CI: 0.07 to 0.48).

CONCLUSIONS

MMR vaccination is effective for the primary prevention of target and not targeted infectious diseases and may also limit hospitalizations for respiratory diseases.

Analysis of measles-related hospitalizations in Tuscany from 2000 to 2014

To evaluate measles incidence and its relevant changes over a 14-year period (2000–2014), we analysed data from the regional hospital discharge database on children and adults hospitalized in Tuscany, Italy. A total of 181 paediatric and 413 adult cases were identified. Despite all the efforts towards regional measles elimination, we observed that the overall measles hospitalization rates for children and adults living in Tuscany globally increased from 0·45 to 0·85/100 000 during the study period (P = 0·001) showing fluctuations due to periodic measles outbreaks. Data stratified by age group showed that the hospitalization rate significantly increased in young adults over the study period, confirming an increase in susceptibility to measles in this subpopulation. Conversely, no statistically significant difference was observed in the hospitalization rate in the other age groups. However, children aged <1 year still exhibit the highest hospitalization rate. Pneumonia represented the most common complication in both the adult and children subsets. No death was reported. Measles still represents a public health problem, and national strategies should be implemented, focusing on emergent susceptible subsets, such as infants and young adults.