bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding hesitancy around vaccines and vaccination: an umbrella review
Authors: Giannakou K , Vachtsioli E 
Published: October 2020

Abstract

Background
Vaccination has been evaluated and was found to be the most successful and cost-effective interventions to preventing illness and improve health outcomes. However, internationally, an increase in vaccine hesitancy has led to a decrease in vaccination uptake. We conducted an umbrella review to assess the factors related to under-vaccination and non-vaccination from a global perspective.

Methods
PubMed, EMBASE and Science Direct were searched from inception to December 2019 for systematic reviews and meta-analyses that examined the factors affecting vaccination choices. No restrictions on language, publication date, vaccination type, setting, or population were applied. Narrative and extensive reviews were excluded. A narrative synthesis was undertaken to present the results thematically.

Results
Twenty-two systematic reviews met the inclusion criteria. The published evidence on this topic shows that, overall, a variety of complex factors exist related to vaccine hesitancy. Across all articles included, the main areas of concern were around vaccine safety and efficacy. Mistrust towards vaccine-related bodies (e.g. pharmaceutical companies, health professionals, researchers etc.), inconvenience, cost, and overall lack of information/knowledge were also identified as major barriers to vaccine uptake. Barriers vary depending on population, place and vaccines.

Conclusions
Our results show a variety of complex factors influencing the decision to accept, delay or reject some or all vaccines, indicating the necessity of a multi-faceted approach to address them in order to improve vaccine coverage.

Key messages
The results of this review show that concerns regarding vaccine safety and efficacy were the most significant barriers. Further research, policies, programs, and community-driven initiatives are needed to enhance acceptability and uptake of vaccination.
Predictors of influenza vaccination uptake among elderly in Croatia
Authors: Miskulin I , Vcev A , Matic Licanin M , Vcev I , Vukoja I , Miskulin M 
Published: October 2020

Abstract

Background
Influenza vaccination (IV) is recommended for elderly but vaccination coverage in this group remains unsatisfactory in Croatia. The aim of this study was to explore IV uptake among elderly from Eastern Croatia and predictors that influence this uptake.

Methods
This cross-sectional questionnaire study was conducted during 2018/2019 influenza season in convenient sample of older adults aged 65 years or more from Eastern Croatia at the primary health care setting.

Results
The study sample consisted of 816 subjects (48.0% males and 52.0% females). The median age of all subjects was 73.0 years (interquartile range (IQR) 69.5 - 79.0 years). The overall prevalence of IV uptake was 33.3%. The IV uptake was statistically more frequent among females (P &lt; 0.001) and old-old subgroup (85 years and older) (P &lt; 0.001). There was no statistically significant difference in IV uptake considering marital status of subjects (P &gt; 0.999). The median number of positive attitudes towards IV was 4.0 (IQR 2.0 - 4.0) and the median number of correct answers was 6.0 (IQR 4.0 - 8.0). The study revealed fair positive correlation between attitudes and IV uptake (rho=0.477; P &lt; 0.001) and poor positive correlation between knowledge and IV uptake (rho=0.242; P &lt; 0.001). The study further showed poor positive correlation between presence of comorbidities and IV uptake (rho=0.187; P &lt; 0.001) and moderate positive correlation between previous year vaccination history and IV uptake (rho=0.669; P &lt; 0.001).

Conclusions
The study showed that observed IV uptake is far below EU target influenza vaccination coverage among elderly of 75%. The study revealed that fairly good predictors of IV uptake in study population were gender, older age group, and previous year vaccination history while attitudes, knowledge and presence of comorbidities were fairly poor predictors. The good predictors of IV uptake among elderly should be taken into account during influenza vaccination popularization strategies development.

Key messages
Understanding the factors that could improve the acceptance of vaccination is crucial to design effective public health interventions. The structured communication campaigns on influenza and influenza vaccines should be developed and directed specifically to elderly as one of target groups for vaccination.
Prevalence of seasonal Influenza vaccination among Tunisian elderly
Authors: Kharroubi G , Cherif I , Bouabid L , Gharbi A , Boukthir A , McCarron M , Ben Alaya N , Ben Salah A , Bettaieb J 
Published: October 2020

Abstract

Background
Surveys to determine the uptake of influenza vaccine (IV) among the at-risk groups are required to evaluate the advancement of national vaccination strategies and the level of awareness in the surveyed population. In this context, the present study aimed to estimate influenza vaccination uptake in elderly in Tunisia during 2018-2019 influenza season and to assess their perceptions toward influenza and IV.

Methods
It was a national cross-sectional study conducted in 2019 in primary and secondary health care facilities, among persons aged 60 years and over with chronic disease. Data were collected using a standard administered questionnaire including questions about IV uptake, general knowledge and attitudes about influenza and IV. Perceptions of participants toward general statements about influenza and IV were compared by vaccination status using chi square test.

Results
In total, 1191 older persons were included. Nearly one third of participants (34.8% [32.2-37.6]) were vaccinated at least once at the past and 19.4% [17.1-21.9] received the vaccine during 2018-2019 influenza season. Compared to unvaccinated elderly, vaccinated persons were significantly more convinced that influenza is more dangerous for elderly people (90.0% vs. 82.2%, p = 0.008), that IV is recommended for older persons (88.7% vs. 70.1%, p &lt; 0.001) and for those with chronic disease (86.1% vs. 64.1%, p &lt; 0.001) and that IV can protect elderly persons (87.9% vs. 71.9%, p &lt; 0.001) and those with chronic disease (88.3% vs. 66.3%, p &lt; 0.001). Regarding attitude about the safety of the vaccine, while 14.4% of unvaccinated persons agreed that IV is not safe for older persons, only 9.5% of vaccinated elderly approved that statement (p = 0.060).

Conclusions
Our study showed a low influenza vaccination rate among Tunisian elderly. In order to promote IV, campaigns should focus on educating elderly regarding the seriousness of influenza and the efficiency and the safety of IV.

Key messages
Efforts must be invested to improve influenza vaccination coverage among Tunisian elderly especially those with chronic diseases. Educating elderly regarding influenza and IV is necessary since knowledge is a basis for adopting relevant attitudes and practices.
A retrospective study of an International Vaccination Centre in the Lisbon Metropolitan Area
Authors: Galhano Lopes D , Bragança Pereira M , Machado Gil M , Duarte S , Moreira A , Cunha I , Abreu Gomes F , Bastos L , Esteves H , Chemela J 
Published: October 2020

Abstract

Background
Vaccination is one of the most cost-effective disease prevention strategies. Trips from Portugal to other countries have increased in the past 5 years. Depending on the destination, certain vaccines are advised to travellers in order to reduce travel-related risk. We analyzed the data of an International Vaccination Centre (IVC) in the Public Health Unit of the Primary Care Centres Group (ACES) of Loures-Odivelas.

Methods
A retrospective observational study comprising data from an IVC database between 2014 and 2018. Variables included were sex, age, destination, purpose, referral, and prescriptions. Descriptive analyses were performed for all variables.

Results
Between 2014 and 2018, there was a total of 4,873 users. Regarding individual characteristics, 51% were female, 80% had between 15 and 64 years of age, and 51% were referred by general practitioners of the ACES. Africa was the leading destination (66% average for all years) with a downward trend (from 82% in 2014 to 47% in 2018) followed by South America (12%) with an upward trend (from 4% to 16% in the same period). The primary purpose of travelling was tourism (74%) followed by work (15%). A total of 7,323 vaccines were administered, with an annual increase from 1,250 administrations in 2014 to 1,862 in 2018. The yellow fever vaccine accounted for 36,9% of all administrations, followed by typhoid fever vaccine (32,3%) and hepatitis A vaccine (10,2%).

Conclusions
African countries are still the most common destination for Portuguese travellers, but changing trends might influence the vaccination strategies in the IVC. Information provided in the IVC can be optimized to suit individual profiles better.

Key messages
As travelling increases, the International Vaccination Centre has an essential role in the prevention of disease. Africa remains the most common destination, requiring pre-travel health counselling and vaccine prophylaxis.
FLUChallenge: an innovative strategy to increase flu vaccination in two Italian Teaching Hospitals
Authors: Barbara A , Azzolini E , DiPumpo M , La Milia D I , Vallone D , Lagioia M , Cambieri A , Damiani G , Ricciardi W , Laurenti P 
Published: October 2020

Abstract
In Europe flu vaccination among healthcare workers (HCWs) is strongly recommended even though not mandatory such as elsewhere (USA). Despite this, vaccination coverage in EU countries is usually low: 30.2% in 2016-17. In Italy, at the end of the same season it was 15.6%. Aim of this study is to describe and evaluate the new strategy adopted by Gemelli and Humanitas Research Hospitals, two Italian Teaching Hospitals (THs) part of the MIRO Public Health Center, to increase the vaccination coverage among their HCWs.
Before the 2019-20 campaign, experts of the two THs met up to identify a common strategy to promote flu vaccination among HCWs in addition to the ones already implemented. It was decided to launch a FLUChallenge: a platform of monitoring updated bi-weekly and available on the THs' internal websites with the vaccination coverage overall and stratified by job category and macro-areas of activity. Descriptive and inferential analysis were performed.

Preliminary Results
6673 HCWs included (4241 Gemelli, 2432 Humanitas). The overall flu vaccination coverage at the end of the 2019-20 campaign was 28.4% (1026 HCWs vaccinated Gemelli, equal to 24.2%; 869 HCWs vaccinated Humanitas, 35.7%). Both THs significantly increased the vaccination coverage compared to the previous year (+10% Gemelli, 22% in 2018-19, p = 0.01; +45.7% Humanitas, 24.5% in 2018-19, p &lt; 0.001). Physicians had the highest coverage both in Gemelli (483/1320, 36.6%) and Humanitas (443/979, 45.2%), while the lowest was registered among nurses in Gemelli (357/2017, 17.7%) and other HCWs in Humanitas (134/605, 22.1%). Infectious disease was the macro-area with highest coverage in Gemelli (32.3%), while in Humanitas the emergency department (63.9%).
The FLUChallenge intervention was an effective strategy to increase flu vaccination coverage in the two TH. The website platform was useful for the purpose of accountability and able to create a positive challenge between the HCWs working in the two THs involved.

Key messages
Flu vaccination among healthcare workers (HCWs) is recommended to prevent influenza and to avoid its transmission. It is important to promote new engagement and innovative strategies to increase flu vaccination coverage among HCWs, when it is not mandatory.
Tailored communication intervention in a Somali community, Sweden, to improve vaccine confidence
Authors: Jama A , Byström E , Rubin J , Kulane A , Lindstrand A , Godoy-Ramirez K 
Published: October 2020

Abstract

Background
Sweden sustains a high and stable vaccination coverage for measles-mumps-rubella (MMR) vaccination (&gt;96%) but despite a high national coverage, there may be local gaps. One example is a Stockholm suburb hosting a population with largely Somali origin that since 1998 has showed low MMR vaccine rates (70%). A baseline study using the Tailoring Immunisation Programme (TIP), child health clinics (CHC) nurses reported poor communication with vaccine hesitant parents who worried that the MMR vaccine may cause autism. Following, a tailored intervention with emphasis on strong and preferred oral communication was designed to address parentś concerns and, seminars to reinforce nurses in improving their encounter with parents.

Methods
The intervention was developed using the TIP guide including an adapted version of the Behaviour Change Wheel model, it included communication tools (films, videos), public seminars in Somali on MMR vaccine, vaccine-preventable diseases and autism, and training of peer parent group. CHC nurses were given tailored seminars with updated information on vaccines with emphasis on how to communicate with vaccine hesitant parents.

Results
Preliminary results suggest that the tools implemented have been well received by all stakeholders and a positive trend in vaccination coverage has been observed. Parents have engaged actively, 32 parents completed the peer-to-peer training and all nurses attended the seminars. Preliminary data of qualitative interviews with 11 nurses indicates that increased knowledge strengthened their confidence to meet the parents and address vaccine hesitancy. The films and information materials facilitated the nursés communication with parents.

Conclusions
Tailored communication interventions need to be tested, implemented and evaluated as tools to motivate change in parental attitudes and to strengthened health care providers role aiming to increase vaccine acceptance and resilience in the immunisation programmes.

Key messages
Tailored communication intervention on vaccination need to be implemented and evaluated as tools to motivate changes in attitudes and behaviours regarding vaccine acceptance. Tailored interventions has been positively received by all target groups and a positive trend in vaccination coverage has been observed.
Flu vaccination coverage among healthcare workers: a comparison between 2018 and 2019 campaigns
Authors: Varadi G , Vacchi O G B , Moretti V , Pozzi D , Chirico L , Del Pin M , Brunelli L , Cocconi R , Brusaferro S 
Published: October 2020

Abstract

Background
In Italy, recommended annual influenza vaccination is free to healthcare workers (HCWs) to prevent flu spread. No official data are available on HCWs' vaccination coverage (VC), which minimum target is set at 75%. Aim of this study is to compare 2019-20 and 2018-19 flu vaccination coverage in order to evaluate last year campaign effectiveness.

Methods
2019-20 flu vaccination campaign efforts at Udine Hospital (Italy) were improved with the aid of public health residents to tackle HCWs convenience concerns. From October 29th to December 5th 2019, dedicated areas and days were increased, informative course about influenza vaccination (efficacy, benefits and safety) toward HCWs were conducted. Data about HCWs getting their flu shot within the hospital were traced and analyzed, grouping different categories.

Results
During 2019-20 flu season, vaccinated HCWs were 29.1% (1,169/4,012), while they were 22.7% (955/4,203) in 2018-19 (p &lt; 0.0001). The 2019-20 campaign resulted to be effective among doctors (45.0% vs 38.4%; p = 0.0132), residents (52.4% vs 40.7%; p = 0.0003) and nurses (24.1% vs 17.3%; p &lt; 0.0001). The less compliant category was midwives, who maintained the worse vaccination coverage in both seasons (20.4% and 24.1%; p = 0.6555). Regarding other HCWs in 2019-20, 18.6% were vaccinated (in 2018-19 14.0%, p = 0.002).

Conclusions
A significant improvement in vaccination coverage during 2019-20 flu season was reached by the specific vaccination campaign for all categories except midwives. Despite this, the global vaccination coverage is still far from the desired target and more must be done to fill this gap. Evidence of HCWs categories for which this intervention was more effective, could be useful in planning next flu vaccination strategies.

Key messages
Continuous efforts made by public health professionals in promoting flu vaccination show their effect on healthcare workers flu shot adherence. A planned vaccination agenda and educative course about influenza infection and benefits of vaccination, seem to be good strategies to improve vaccination coverage.
Monitoring regional-level vaccination coverage rates in Lombardy Region (Northern Italy)
Authors: Croci R , Rossi D , Odone A , Signorelli C 
Published: October 2020

Abstract

Background
Lombardy is Italy's most affluent and most populated region, with the highest national per capita GDP, and over 10 million residents - more than 16 out of 27 EU countries. In 2017, two measures were approved against vaccine hesitancy, i.e. the National Plan for Vaccine Prevention (2017-2019) and Law no. 119 on mandatory vaccinations. Aim of the study is to monitor Lombardy regional-level vaccine coverage trends and to assess the new legislative framework's overall impact.

Methods
We analysed and critically interpreted Lombardy regional-level vaccination coverage (2000-2018 for childhood vaccinations; birth cohorts 1997-2005 for HPV; flu seasons 1999-2000/2018-2019 for influenza). All data were extracted from the Italian Ministry of Health website. We carried out descriptive trend analysis for measles and polio-containing vaccines in 24 month-old-children, Human Papilloma Virus vaccine in 12-year-old females, and influenza vaccine in seniors over 65 years. Regional data were compared with the corresponding Italian national averages.

Results
Childhood vaccinations: Lombardy and Italy have never met the 95% target for measles-containing vaccines (average coverage 2000-2018: Lombardy 91,79%, Italy 86,94%). Polio-containing vaccines have always remained above the 95% threshold, with a drop in 2015-2017. In 2018 they increased back to safety levels (Lombardy 95,31%, Italy 95,09%). HPV: coverage has always kept below WHO/SAGE intermediate 80% goal (average coverage, birth cohorts 1997-2005: Lombardy 75,58%, Italy 72,73%). Influenza: mean coverage has been alarmingly inadequate (Lombardy 54,09%, Italy 57,98%) compared to WHO-recommended minimum of 75%.

Conclusions
Except for influenza, coverage in Lombardy is slightly higher than the Italian average. Exploring Lombardy's response to the national legislation could guide policymakers in developing tailored vaccination strategies.

Key messages
Overall, vaccination coverage in Lombardy is slightly higher than the Italian average. In 2017, law n.119 on mandatory vaccinations came into force, acting as a powerful tool for coverage increase.
Pertussis in Italy: maternal immunization to protect infants
Authors: Fiasca F , Necozione S , Mattei A 
Published: October 2020

Abstract

Background
Despite effective pertussis vaccines and high rates of pediatric vaccination in Italy, the number of reported pertussis cases has steadily increased. To minimize severe illness and deaths, particularly in infants, in addition to active immunization, maternal vaccination has been nationally recommended. To support this prevention measure, this study sought to gain more insight into the current pertussis burden among hospitalized infants.

Methods
A retrospective observational study investigating infant hospitalizations for pertussis within the first year of life from 2007 to 2018 in Italy was carried out using the Hospital Discharge Database as informational flow. Four age groups were analyzed (&lt;3, 3-4, 5-10, and 11-12 months), according to the expected age for the dose administration of the primary course of pertussis vaccination. The temporal trend of hospitalization rates was analyzed by the slope of the regression line. p &lt; 0.05 was the criterion for statistical significance.

Results
There were 4262 pertussis-related admissions among infants less than 12 months of age. Overall, 61.10% were infants aged &lt;3 months. The overall hospitalization rate was 69 x 100000 infants. When stratified by age, infants &lt;3 months old had the highest hospitalization rate at 169 x 100000 infants, with an increasing trend (β = 9.12, p = 0.002); for the other age groups, the trend increased less strongly or was substantially stable.

Conclusions
This nationwide study highlighted that most of the pertussis admissions in Italy occurred in the first few months of life, before infants had started the primary vaccination course. This result indicates that more needs to be done to protect young infants (&lt;3 months) who are the most vulnerable to severe disease. The implementation of maternal immunization programs could offer the hope of much better pertussis control in infants too young to be vaccinated.

Key messages
Infants aged &lt;3 months showed the highest rates of hospitalization for pertussis, with an increasing trend. The implementation of maternal immunization programs could protect these high-risk infants.
Vaccine prevention at the time of covid-19: the ASL Roma 4 experience
Authors: Fusillo C , Galliano E , Belfiori G , Marchini R , Turci C , Ursino S , Matera C , Quintavalle G , Sinopoli M T 
Published: October 2020

Abstract
The end of January 2020 WHO sanctioned an international public health emergency and the Italian government issued directives with urgent measures to counter and manage the epidemiological emergency: bans, suspensions of activities have profoundly changed school, work and health social life which have an impact on vaccination prevention
Vaccinations Service (VS) of ASL Roma 4 vaccinates people of all ages and the healthcare professional (HP) noticed that the fear in the population is making the accesses less frequent and the vaccination coverage decrease and the infectious diseases will re-emerge. DPCM 4/3/2020 has established rules to contain the virus, the ASL task force and VS adopted and adapted them for a protected vaccination activity. Results Surgeries are cleaned more frequently and fomites have been removed. The rules were published on the ASL website, social networks, displayed on posters posted before entering the clinic and waiting rooms: vigilantes lets you enter without crowding the waiting room; only one parent enters; the adult enters alone; if you have a cough or sneeze cover your nose and mouth with a tissue or ask for the surgical mask, wash your hands with the disinfectant gel, sit only in the spaced chair. Inside the children find a nice poster with drawings to explain how to avoid the virus to be colored at home. Health care workers wear masks designed to calm children. As long as the epidemiological situation allows the vaccine prevention activity must be maintained. HP must give messages of trust for activities that are carried out safely. An emergency plan within the VS also provides the behavior to be used in the event that many health workers fall ill. At the time of Covid-2019 infection all forms of prevention are to be remodeled, not just vaccine prevention. Reducing the preventive actions could in a short time lead to the emergence of infectious diseases and not only with consequent important damages, including economic ones

Key messages
Healthcare professionals must give messages of trust for activities that are carried out safely. At the time of Covid-2019 infection all forms of prevention are to be remodeled, not just vaccine prevention.