Comparison between recommended and mandatory vaccine uptake during adolescence in Italy

Abstract Background Immunization programs are key preventive interventions and have largely contributed to reducing the burden of infectious diseases and decreasing related morbidity, mortality and healthcare costs. The study aimed to investigate coverage regarding diphtheria, tetanus, and acellular pertussis (dTap) - Inactivated Poliomyelitis Vaccine (IPV) and Human Papilloma Virus (HPV) vaccine and attitudes towards vaccinations among undergraduate university students in Southern Italy. Methods This cross-sectional study was conducted among 327 students through an anonymous online questionnaire and included socio-demographic characteristics, attitudes towards vaccinations overall and specifically on dTap-IPV and HPV, reasons for having received or not vaccinations and willingness to receive vaccinations. Results One third of the students were concerned about serious adverse effects of vaccines and 95% believed that vaccines for uncommon diseases are useless. During adolescence, 89% of the sample received the mandatory dTap-IPV vaccine booster. Among unvaccinated students, 45% were unwilling to get vaccinated against dTap-IPV because they believed not to be at risk of infection (59%) and had lack of recommendation (35.3%). Regarding vaccination against HPV, 67% had received the recommended schedule. Among those who did not receive it, 34% were unwilling to get vaccinated because they did not feel at risk of HPV infection (41%). Interestingly, 16% of the sample disclosed some barriers to access vaccination centers. Moreover, 30% declared that HPV vaccination was discouraged by healthcare professionals (HCPs). Conclusions Vaccination uptake is worryingly low and national objective coverage seems not still achieved. Likewise, risk perception of vaccine-preventable diseases was low and it seems negatively impact on the intention to get vaccinated. Improving vaccine confidence among HCPs is crucial as they have been shown to have the potential to influence patient vaccination uptake. Key messages Skilled communication with a trusted HCP could increase acceptance of vaccine during adolescence and address vaccine hesitancy. Strategies to disseminate information on vaccines should be established to increase mandatory and recommended vaccines coverage.


Background:
Immunization programs are key preventive interventions and have largely contributed to reducing the burden of infectious diseases and decreasing related morbidity, mortality and healthcare costs. The study aimed to investigate coverage regarding diphtheria, tetanus, and acellular pertussis (dTap) -Inactivated Poliomyelitis Vaccine (IPV) and Human Papilloma Virus (HPV) vaccine and attitudes towards vaccinations among undergraduate university students in Southern Italy.

Methods:
This cross-sectional study was conducted among 327 students through an anonymous online questionnaire and included socio-demographic characteristics, attitudes towards vaccinations overall and specifically on dTap-IPV and HPV, reasons for having received or not vaccinations and willingness to receive vaccinations.

Results:
One third of the students were concerned about serious adverse effects of vaccines and 95% believed that vaccines for uncommon diseases are useless. During adolescence, 89% of the sample received the mandatory dTap-IPV vaccine booster. Among unvaccinated students, 45% were unwilling to get vaccinated against dTap-IPV because they believed not to be at risk of infection (59%) and had lack of recommendation (35.3%). Regarding vaccination against HPV, 67% had received the recommended schedule. Among those who did not receive it, 34% were unwilling to get vaccinated because they did not feel at risk of HPV infection (41%). Interestingly, 16% of the sample disclosed some barriers to access vaccination centers. Moreover, 30% declared that HPV vaccination was discouraged by healthcare professionals (HCPs).

Conclusions:
Vaccination uptake is worryingly low and national objective coverage seems not still achieved. Likewise, risk perception of vaccine-preventable diseases was low and it seems negatively impact on the intention to get vaccinated. Improving vaccine confidence among HCPs is crucial as they have been shown to have the potential to influence patient vaccination uptake. Key messages: Skilled communication with a trusted HCP could increase acceptance of vaccine during adolescence and address vaccine hesitancy. Strategies to disseminate information on vaccines should be established to increase mandatory and recommended vaccines coverage. Background: Overweight and obesity rates are increasing worldwide, particularly among people with a low socioeconomic status (SES). Care-physical activity (care-PA) initiatives may lower overweight and obesity rates. A two-year care-PA initiative specifically developed for citizens with a low SES, X-Fittt 2.0, included 12 weeks of intensive guidance and sports sessions, and 21 months of aftercare. We answered the research question: what are the short-and long-term outcomes of participation in X-Fittt 2.0 in terms of health, quality of life and societal participation? Methods: Questionnaires and body measurements were taken from 208 participants at the start of X-Fittt 2.0 (t0) and after 12 weeks (t1), 1 year (t2) and 2 years (t3). We also held 17 group discussions (t1, n = 71) and 68 semi-structured interviews (t2 and t3). Continuous variables were analysed using linear mixed-model analysis, while we used descriptive statistics for the categorical variables. Qualitative data were analysed using thematic analysis.

Results:
Body weight was significantly lower at all three post-initiative time points compared with t0, with a maximum of 3.8 kg difference at t2 (p < 0.05). BMI, waist circumference, blood pressure and self-perceived health only significantly improved during the first 12 weeks (p < 0.05). A positive trend regarding paid work was observed, participants reported increased PA levels (including sports) and a few stopped smoking or drinking alcohol. Participants felt healthier and more energetic, reported improved self-esteem and stress levels, and had become more socially active. However, barriers to being physically active included a lack of money or time, or physical or mental health problems.
Conclusions: X-Fittt 2.0 improved the physical health, QoL and societal participation of the participants. Future initiatives should take into account the aforementioned barriers, and consider a longer intervention period for more sustainable results.

Key messages:
Care-physical activity initiatives can improve the physical and mental health, quality of life, lifestyle and societal participation of citizens with a low socioeconomic status. It is vital to improve the accessibility of care-physical activity initiatives, for example by lowering costs, so that existing and future initiatives better suit people with low socioeconomic status.