Pneumococcal vaccine uptake among high-risk adults and children in Italy: results from the OBVIOUS project survey
Authors: Di Valerio Zeno , La Fauci Giusy , Scognamiglio Francesca , Salussolia Aurelia , Montalti Marco , Capodici Angelo , Fantini Maria Pia , Odone Anna , Costantino Claudio , Soldà Giorgia , Larson Heidi J. , Leask Julie , Lenzi Jacopo , Gori Davide ,   the OBVIOUS board, Capodici Angelo , Conversano Michele , Costantino Claudio , Esposti Mirko Degli , Di Valerio Zeno , Fantini Maria Pia , Gori Davide , Grignolio Andrea , La Fauci Giusy , Larson Heidi , Leask Julie , Lenzi Jacopo , Montalti Marco , Odone Anna , Remondini Daniel , Scognamiglio Francesca , Salussolia Aurelia , Soldà Giorgia , Toth Federico , Vitale Francesco 
Published: March 2024

Abstract
Background
Streptococcus pneumoniae infections, including Invasive Pneumococcal Diseases (IPDs), pose a substantial public health challenge, causing significant morbidity and mortality, especially among children and older adults. Vaccination campaigns have played a vital role in reducing pneumococcal-related deaths. However, obstacles related to accessibility and awareness might impede optimal vaccine adoption. This study aims to provide comprehensive data on pneumococcal vaccine coverage and attitudes within at-risk groups in Italy, with the goal of informing public health strategies and addressing vaccination barriers.

Methods
Between April 11 and May 29, 2022, a questionnaire investigating vaccine uptake and attitudes toward several vaccinations was administered to 10,000 Italian adults, chosen through population-based sampling. Respondents who were targets of the campaign according to the 2017–2019 National Vaccination Plan, accessed questions regarding pneumococcal vaccination. Data on uptake, awareness of having the right to free vaccination, opinion on vaccine safety, concern with pneumococcal disease, and ease of access to vaccination services were summarized and presented based on statistical regions. Multinomial logistic regression analysis was used to explore factors influencing vaccine uptake.

Results
Out of 2357 eligible adult respondents (42.6% women; mean age: 58.1 ± 15.7), 39.5% received pneumococcal vaccination. Uptake differed among at-risk groups: respondents aged ≥65 (33.7%), with lung disease (48.4%), cardiovascular disease (46.6%), and diabetes (53.7%). Predictors of not being vaccinated and unwilling to included female gender, residing in rural areas, lower education, low concern about pneumococcal disease, vaccine safety concerns, and associations with vaccine-opposed acquaintances. Health access issues predicted willingness to be vaccinated despite non-vaccination. Pneumopathy, heart disease, diabetes, and living in Northeastern or Central Italy were linked to higher uptake. Among the 1064 parents of eligible children, uptake was 79.1%. Parental unawareness of children’s free vaccination eligibility was a predictor of non-vaccination. Vaccine safety concerns correlated with reluctance to vaccinate children, while perceived healthcare access challenges were associated with wanting but not having received vaccination.

Conclusions
Pneumococcal vaccination uptake within prioritized groups and children in Italy remains inadequate. Scarce awareness of vaccine availability and obstacles in accessing vaccinations emerge as principal barriers influencing this scenario.