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Introduction: The COVID-19 global pandemic is having a widespread impact on medical care. A general reduction, in routine vaccination activities, could occur. In Tuscany (Central Italy), paediatricians (in agreement with the regional health service) administer and register paediatric vaccinations of their assisted population. The aim of the present study was to evaluate the impact of the COVID-19 epidemic on paediatric vaccination activities performed by Tuscan paediatricians, as a proxy of the adherence to vaccinations during this epidemic period. Methods: Four hundred members belonging to the Tuscany section of the Italian Federation of Paediatricians (FIMP) were invited to answer to a semi-structured online survey. Results: During the COVID-19 pandemic, among 223 respondent paediatricians, almost all (98.2%) reported a general decline in outpatient paediatric visits; 65.8% of them reported more than 60% reduction (144 answers) compared to the situation before the COVID-19 pandemic. Among all paediatricians, 93.3% (208) guaranteed vaccination activities in the considered period: 66/208 paediatricians (31.7%) reported a reduction in the compliance of parents to mandatory vaccination (hexavalent and MMRV vaccines), and 88/208 paediatricians (42.3%) to non-mandatory vaccinations. Almost all paediatricians declared to have taken preventive actions to counter the spread of SARS-CoV-2. Discussion and conclusions: Although the majority of Tuscan paediatricians guaranteed vaccination practice during the lockdown, some parents decided to postpone the scheduled vaccinations for their children, mainly due to fears concerning the safety of access to health services. When Italian immunization coverage data of the first months of 2020 will be available, it will be possible to definitely assess the real impact of COVID-19 pandemic on paediatric vaccination. It is crucial to continue vaccinating against preventable infectious diseases in order to avoid other possible epidemics.&n

The inadequate formation and knowledge about vaccinations of healthcare workers, including doctors, has certainly contributed to the spread of the vaccine hesitancy in recent years. Therefore, it is essential to improve the level of knowledge of future doctors so that they can deal with any hesitation within the population in order to increase the vaccination coverage. The aim of the study is to evaluate the impact of a course about vaccination on the knowledge of medical students. In order to evaluate the efficacy of a certain lecture about vaccinations on medical students, they were asked to complete an anonymous questionnaire before and after the seminar. The two questionnaires contained the same 10 questions regarding knowledge and attitudes about vaccines. Only the students who had attended the lecture were allowed to complete the post-lecture questionnaire. The students could fulfil the questionnaires through the learning management system (LMS) called ‘Moodle’. A descriptive statistical analysis of the data collected through the comparative evaluation of the answers before and after the seminar was performed. The seminar aroused much interest among the students: 100 of them completed the pre-lecture questionnaire and 81 of them completed the post-lecture questionnaire. The results show a positive impact of the seminar, especially about some specific themes: knowledge of the students on the indication of the MPR vaccine strongly improved after the seminar, the number of students who would recommend vaccination for pertussis and influenza during pregnancy increased by 37% and 19% respectively after the seminar, and those aware of the need for Herpes Zoster vaccination over the age of 65 increased by 22%. For future doctors, a thorough knowledge about vaccinations is increasingly required in order to deal with vaccine hesitancy. It is, therefore, important for them to get the opportunity to develop a mastery over these topics. An extracurricular seminar about va

ObjectiveThe aim of this paper is to describe the results obtained from the application of a specific local deprivation index, calculated on the basis of 2011 Census sections, to general and cause-specific mortality and influenza vaccination coverage among elderly people of the municipality of Florence.MethodsGeneral and cause-specific mortality data (2009-2013) and influenza vaccination coverage data (2015/16 and 2016/17) have been collected for subjects aged ≥65 years residing in the municipality of Florence (Tuscany), at the 2011 Census section level. Socio-Economic and Health Deprivation Index (SEHDI) has been constructed and validated by using socio-economic indicators and mortality ratios.ResultsHalf the Florence population belongs to the medium deprivation group; about 25% belongs to the two most deprived groups, and the remaining 25% is wealthy. Elderly people mostly belong to the high deprivation group. All-cause mortality and cause-specific mortality (cancer and respiratory diseases) reach the highest values in the high deprivation group.Influenza vaccination coverage (VC) is 54.7% for the seasons 2015/16 and 2016/17, combined. VC shows a growing linear trend as deprivation increases. VC appears to be correlated with different factors in the different deprivation groups.ConclusionsSocio-economic deprivation plays an important role in health choices, so the application of SEHDI allows to identify the characteristics of the main sub-groups of the population with a low adherence to influenza vaccination. Results of the present study should be spread to General Practitioners in order to help them to promote influenza vaccination to their patients.

BackgroundAlthough benefits of vaccinations have been extensively demonstrated, poor knowledge of the population has resulted in non-optimal vaccine coverage as a result of the hesitancy and negative perception of many parents toward vaccination. Materials and MethodsTo assess the impact of a course on the knowledge and attitudes of future mothers on vaccination, 214 pregnant women participated in a research project undertaken at the Obstetrics and Gynaecology Department of the Careggi University Hospital in Florence (Italy). This involved completion of anonymous questionnaires administered before and after the intervention. A descriptive and statistical analysis was carried out on the results of the collected data by performing comparative evaluations of the responses obtained before and after the intervention. ResultsThere was good adherence to the initiative (98%): the sample population was initially not hostile to vaccines, albeit poorly or insufficiently informed (43%). The educational intervention had a positive impact, especially as a vaccine information tool and for correctly addressing the vaccine hesitancy. After the intervention, women who considered their level of knowledge about vaccines as poor or insufficient were reduced by 30% and the "hesitant" ones were reduced with respect to all aspects of the study, especially about the decision to be vaccinated during pregnancy. ConclusionsHesitancy finds its roots in the absence of accurate information. Healthcare professionals need to improve their communication skills. Competent education delivered during pregnancy, when women are more receptive, may have a highly positive impact. These observations will have to be considered in the planning of delivery preparation courses.

The inadequate formation and knowledge about vaccinations of healthcare workers, including doctors, has certainly contributed to the spread of the vaccine hesitancy in recent years. Therefore, it is essential to improve the level of knowledge of future doctors so that they can deal with any hesitation within the population in order to increase the vaccination coverage. The aim of the study is to evaluate the impact of a course about vaccination on the knowledge of medical students. In order to evaluate the efficacy of a certain lecture about vaccinations on medical students, they were asked to complete an anonymous questionnaire before and after the seminar. The two questionnaires contained the same 10 questions regarding knowledge and attitudes about vaccines. Only the students who had attended the lecture were allowed to complete the post-lecture questionnaire. The students could fulfil the questionnaires through the learning management system (LMS) called ‘Moodle’. A descriptive statistical analysis of the data collected through the comparative evaluation of the answers before and after the seminar was performed. The seminar aroused much interest among the students: 100 of them completed the pre-lecture questionnaire and 81 of them completed the post-lecture questionnaire. The results show a positive impact of the seminar, especially about some specific themes: knowledge of the students on the indication of the MPR vaccine strongly improved after the seminar, the number of students who would recommend vaccination for pertussis and influenza during pregnancy increased by 37% and 19% respectively after the seminar, and those aware of the need for Herpes Zoster vaccination over the age of 65 increased by 22%. For future doctors, a thorough knowledge about vaccinations is increasingly required in order to deal with vaccine hesitancy. It is, therefore, important for them to get the opportunity to develop a mastery over these topics. An extracurricular seminar about va

ObjectiveThe aim of this paper is to describe the results obtained from the application of a specific local deprivation index, calculated on the basis of 2011 Census sections, to general and cause-specific mortality and influenza vaccination coverage among elderly people of the municipality of Florence.MethodsGeneral and cause-specific mortality data (2009-2013) and influenza vaccination coverage data (2015/16 and 2016/17) have been collected for subjects aged ≥65 years residing in the municipality of Florence (Tuscany), at the 2011 Census section level. Socio-Economic and Health Deprivation Index (SEHDI) has been constructed and validated by using socio-economic indicators and mortality ratios.ResultsHalf the Florence population belongs to the medium deprivation group; about 25% belongs to the two most deprived groups, and the remaining 25% is wealthy. Elderly people mostly belong to the high deprivation group. All-cause mortality and cause-specific mortality (cancer and respiratory diseases) reach the highest values in the high deprivation group.Influenza vaccination coverage (VC) is 54.7% for the seasons 2015/16 and 2016/17, combined. VC shows a growing linear trend as deprivation increases. VC appears to be correlated with different factors in the different deprivation groups.ConclusionsSocio-economic deprivation plays an important role in health choices, so the application of SEHDI allows to identify the characteristics of the main sub-groups of the population with a low adherence to influenza vaccination. Results of the present study should be spread to General Practitioners in order to help them to promote influenza vaccination to their patients.

BackgroundAlthough benefits of vaccinations have been extensively demonstrated, poor knowledge of the population has resulted in non-optimal vaccine coverage as a result of the hesitancy and negative perception of many parents toward vaccination. Materials and MethodsTo assess the impact of a course on the knowledge and attitudes of future mothers on vaccination, 214 pregnant women participated in a research project undertaken at the Obstetrics and Gynaecology Department of the Careggi University Hospital in Florence (Italy). This involved completion of anonymous questionnaires administered before and after the intervention. A descriptive and statistical analysis was carried out on the results of the collected data by performing comparative evaluations of the responses obtained before and after the intervention. ResultsThere was good adherence to the initiative (98%): the sample population was initially not hostile to vaccines, albeit poorly or insufficiently informed (43%). The educational intervention had a positive impact, especially as a vaccine information tool and for correctly addressing the vaccine hesitancy. After the intervention, women who considered their level of knowledge about vaccines as poor or insufficient were reduced by 30% and the "hesitant" ones were reduced with respect to all aspects of the study, especially about the decision to be vaccinated during pregnancy. ConclusionsHesitancy finds its roots in the absence of accurate information. Healthcare professionals need to improve their communication skills. Competent education delivered during pregnancy, when women are more receptive, may have a highly positive impact. These observations will have to be considered in the planning of delivery preparation courses.

Introduction: Tuscany region (Italy) recorded a rise in the number of meningococcal disease cases between January 2015 and February 2016,(52 cases) compared to 2014(16 cases). The aim of this study was to describe the emergency meningococcal C (MenC) vaccination programme in Tuscany and the population’s adherence to the activities performed in the Local Health Unit (LHU) of Florence.Methods:The MenC vaccination programme and the planning of the prevention and communication activities were analysed in the LHU of Florence. As an indicator of population’s adherence, the vaccination coverage (VC)during the emergency campaignwas investigated and adverse drug reactions (ADR) surveillance was reported.Results:The communication campaign included a dedicated toll-free telephone number, press releases (newspapers, radio, television, websites), and informative letters addressed to mayors, secondary schools, and sports associations. Citizens aged 11–20 years were the primary target of the campaign. Due to the high incidence of cases among older people, the vaccination was extended to subjectsover 45 years. The population’s adherence to the vaccination campaignwas satisfactory: VC reached 47.1%for the primary target. The ADR reporting rate (3.1/10,000) on meningococcal disease in our study confirmed the safety of the vaccination.Conclusions:In 2017, only 10 IMD cases were reported, suggesting the effectiveness of the immunization campaign. Similar VC during emergency MenC vaccination programmes have been reached in other Italian regions and other EU countries, too.The achievement of greater vaccination coverage is restricted by a sentiment of hesitancy towards vaccines among the general population.

Introduction: Tuscany region (Italy) recorded a rise in the number of meningococcal disease cases between January 2015 and February 2016,(52 cases) compared to 2014(16 cases). The aim of this study was to describe the emergency meningococcal C (MenC) vaccination programme in Tuscany and the population’s adherence to the activities performed in the Local Health Unit (LHU) of Florence.Methods:The MenC vaccination programme and the planning of the prevention and communication activities were analysed in the LHU of Florence. As an indicator of population’s adherence, the vaccination coverage (VC)during the emergency campaignwas investigated and adverse drug reactions (ADR) surveillance was reported.Results:The communication campaign included a dedicated toll-free telephone number, press releases (newspapers, radio, television, websites), and informative letters addressed to mayors, secondary schools, and sports associations. Citizens aged 11–20 years were the primary target of the campaign. Due to the high incidence of cases among older people, the vaccination was extended to subjectsover 45 years. The population’s adherence to the vaccination campaignwas satisfactory: VC reached 47.1%for the primary target. The ADR reporting rate (3.1/10,000) on meningococcal disease in our study confirmed the safety of the vaccination.Conclusions:In 2017, only 10 IMD cases were reported, suggesting the effectiveness of the immunization campaign. Similar VC during emergency MenC vaccination programmes have been reached in other Italian regions and other EU countries, too.The achievement of greater vaccination coverage is restricted by a sentiment of hesitancy towards vaccines among the general population.

The World Health Organization (WHO) has established specific targets for control, elimination or eradication of some vaccine preventable infectious diseases, which were periodically updated. In Italy, WHO recommendations have been endorsed and implemented over time, through the national and regional health prevention plans. The aim of the study was to assess the impact of the immunization practices against measles, varicella and Neisseria meningitidis type C (Men C) in Italy and in Tuscany Region, during the last decades, by analyzing national and regional surveillance databases. Benefits of vaccination strategies were discussed from different points of view (clinical, epidemiological, economic, ethical, social and communicative). The implementation of measles, varicella and Men C vaccination, caused a considerable decrease of incidence rates over the years in Italy and in Tuscany too. However, in the last years, notifications of measles and Men C cases in subjects not targeted by immunization campaigns, in Italy and in Tuscany, are a cause for concern for public health and for the achievement of the elimination goals. Achieving and maintaining high vaccine coverage guarantees a decrease in the incidence of serious diseases and their clinical and economic consequences, but it is necessary to strengthen surveillance system of infectious diseases in order to monitor epidemiological trends. Moreover, outreach campaigns are necessary to raise awareness in the general population and create the culture of prevention with the same nationwide health goals for all.

The World Health Organization (WHO) has established specific targets for control, elimination or eradication of some vaccine preventable infectious diseases, which were periodically updated. In Italy, WHO recommendations have been endorsed and implemented over time, through the national and regional health prevention plans. The aim of the study was to assess the impact of the immunization practices against measles, varicella and Neisseria meningitidis type C (Men C) in Italy and in Tuscany Region, during the last decades, by analyzing national and regional surveillance databases. Benefits of vaccination strategies were discussed from different points of view (clinical, epidemiological, economic, ethical, social and communicative). The implementation of measles, varicella and Men C vaccination, caused a considerable decrease of incidence rates over the years in Italy and in Tuscany too. However, in the last years, notifications of measles and Men C cases in subjects not targeted by immunization campaigns, in Italy and in Tuscany, are a cause for concern for public health and for the achievement of the elimination goals. Achieving and maintaining high vaccine coverage guarantees a decrease in the incidence of serious diseases and their clinical and economic consequences, but it is necessary to strengthen surveillance system of infectious diseases in order to monitor epidemiological trends. Moreover, outreach campaigns are necessary to raise awareness in the general population and create the culture of prevention with the same nationwide health goals for all.

Introduction Chronic viral hepatitis is still a major public health concern in the EU. In order to halt the progression of the disease and to prevent onward transmission, timely recognition and accurate clinical management are crucial. The aim of the present study was to investigate the role of the general practitioner (GP) in the screening of persons at risk and in the clinical management of chronic viral hepatitis patients in six EU countries.Methods An online survey among GPs and secondary care specialists was conducted in the UK, Germany, the Netherlands, Hungary, Italy, and Spain. In the GP survey we aimed to find out how commonly risk groups are screened, using a four-point Likert scale. In both surveys, we measured whether GPs are involved in monitoring clinical indicators in patients undergoing antiviral treatment and explored whether patients in four clinical scenarios are referred back to primary care.Results Between five and 10 experts per professional group were reached except for Spain (GPs: n=2; Specialists: n=4) and, in the case of the GP survey, Hungary (GPs: n=4) and Germany (GPs: n=4). Migrants are variably or not routinely screened for Hepatitis B/C in the majority of cases. The majority of GPs reported that hepatitis B/C screening is routinely offered to people who inject drugs. In Hungary, Italy and in the Netherlands screening sex workers is not regularly practiced. As to whether GPs offer screening to men having sex with men, responses varied between variably and commonly practiced in Germany, the Netherlands and Italy, while in Hungary the practice seems to be sporadic; in the UK, while screening for hepatitis B seems to be common practice among GPs, hepatitis C testing is only occasionally offered to this risk group. Most GPs (>44%) in all countries except in Hungary reported that it is very common practice to offer hepatitis B/C screening to HIV patients.The role of the GPs in monitoring hepatitis cases and the referral of cases back to

Introduction Chronic viral hepatitis is still a major public health concern in the EU. In order to halt the progression of the disease and to prevent onward transmission, timely recognition and accurate clinical management are crucial. The aim of the present study was to investigate the role of the general practitioner (GP) in the screening of persons at risk and in the clinical management of chronic viral hepatitis patients in six EU countries.Methods An online survey among GPs and secondary care specialists was conducted in the UK, Germany, the Netherlands, Hungary, Italy, and Spain. In the GP survey we aimed to find out how commonly risk groups are screened, using a four-point Likert scale. In both surveys, we measured whether GPs are involved in monitoring clinical indicators in patients undergoing antiviral treatment and explored whether patients in four clinical scenarios are referred back to primary care.Results Between five and 10 experts per professional group were reached except for Spain (GPs: n=2; Specialists: n=4) and, in the case of the GP survey, Hungary (GPs: n=4) and Germany (GPs: n=4). Migrants are variably or not routinely screened for Hepatitis B/C in the majority of cases. The majority of GPs reported that hepatitis B/C screening is routinely offered to people who inject drugs. In Hungary, Italy and in the Netherlands screening sex workers is not regularly practiced. As to whether GPs offer screening to men having sex with men, responses varied between variably and commonly practiced in Germany, the Netherlands and Italy, while in Hungary the practice seems to be sporadic; in the UK, while screening for hepatitis B seems to be common practice among GPs, hepatitis C testing is only occasionally offered to this risk group. Most GPs (>44%) in all countries except in Hungary reported that it is very common practice to offer hepatitis B/C screening to HIV patients.The role of the GPs in monitoring hepatitis cases and the referral of cases back to

HTA is considered the most comprehensive and transparent method of supporting decision-makers in their choices in Public Health.HTA on vaccines is being performed by many experts. However, they often present their studies to colleagues, but not to decision-makers, who should be the main target and current users. It is therefore crucial to improve the transfer of scientific data to decision-makers and all stakeholders.The aims of the present project are: 1) to set up a team of experts to collect economic evaluations and HTA studies on vaccines and assess their actual use in decision-making processes; 2) to constitute regional working groups in order to identify the critical aspects of the communication process and identify the most appropriate method of data transfer.Systematic reviews of economic evaluations and HTA on vaccines and their actual use in decision-making will be used to draw up the basic documents for discussion by the 3 regional working boards. The working groups will discuss the current scientific evidence and communication methods and will try to implement a model of technology assessment with well-defined and objective criteria, in order to better fit pharmaco-economic and HTA methods to the field of vaccinations.Improving the transfer of HTA results to stakeholders, particularly decision-makers, will enable decisions to be taken on the basis of scientific evidence, and appropriate, sustainable actions to be undertaken.

HTA is considered the most comprehensive and transparent method of supporting decision-makers in their choices in Public Health.HTA on vaccines is being performed by many experts. However, they often present their studies to colleagues, but not to decision-makers, who should be the main target and current users. It is therefore crucial to improve the transfer of scientific data to decision-makers and all stakeholders.The aims of the present project are: 1) to set up a team of experts to collect economic evaluations and HTA studies on vaccines and assess their actual use in decision-making processes; 2) to constitute regional working groups in order to identify the critical aspects of the communication process and identify the most appropriate method of data transfer.Systematic reviews of economic evaluations and HTA on vaccines and their actual use in decision-making will be used to draw up the basic documents for discussion by the 3 regional working boards. The working groups will discuss the current scientific evidence and communication methods and will try to implement a model of technology assessment with well-defined and objective criteria, in order to better fit pharmaco-economic and HTA methods to the field of vaccinations.Improving the transfer of HTA results to stakeholders, particularly decision-makers, will enable decisions to be taken on the basis of scientific evidence, and appropriate, sustainable actions to be undertaken.

Introduction. Post-licensure vaccine safety studies are essential to identify uncommon events that may be difficult to assess during prelicensure studies. The aim of our study was to evaluate the safety of serogroup C meningococcal conjugate (MCC) vaccine in Tuscany from 2005 to 2012. Methods. All adverse events (AEs) to MCC vaccine notified from 2005 to 2012 were obtained from the regional health authority. Results. Following 451,570 doses administered, 110 suspected AEs were notified (mean annual reporting rate: 2.8/10,000 doses). The most frequently AE reported was fever (60%), fol- lowed by swelling at the injection site (11%) and febrile seizures (10%). Overall, 77.3% of cases were not severe, while 21.8% required hospitalization. Almost four months after the receipt of the vaccine, a one-year-old infant was diagnosed with a pervasive developmental disorder with disturbance of speech, but any link with the vaccinations received was refuted. Most AEs (80.9%) occurred after co-administration with other vaccines, especially with MMR or MMRV vaccines (42.7%) or the DTPa-HBV-IPV/ Hib vaccine (33.7%). Discussion. Our study confirmed the high level of safety of MCC vaccine in Tuscany: AEs proved rare and all cases had only tem- porary and self-resolving consequences. As usually only the most severe suspected AEs are reported, the true proportion of AEs requiring hospitalization was most probably overestimated, and it is plausible that most of these cases were in fact only temporally related.

Introduction. Post-licensure vaccine safety studies are essential to identify uncommon events that may be difficult to assess during prelicensure studies. The aim of our study was to evaluate the safety of serogroup C meningococcal conjugate (MCC) vaccine in Tuscany from 2005 to 2012. Methods. All adverse events (AEs) to MCC vaccine notified from 2005 to 2012 were obtained from the regional health authority. Results. Following 451,570 doses administered, 110 suspected AEs were notified (mean annual reporting rate: 2.8/10,000 doses). The most frequently AE reported was fever (60%), fol- lowed by swelling at the injection site (11%) and febrile seizures (10%). Overall, 77.3% of cases were not severe, while 21.8% required hospitalization. Almost four months after the receipt of the vaccine, a one-year-old infant was diagnosed with a pervasive developmental disorder with disturbance of speech, but any link with the vaccinations received was refuted. Most AEs (80.9%) occurred after co-administration with other vaccines, especially with MMR or MMRV vaccines (42.7%) or the DTPa-HBV-IPV/ Hib vaccine (33.7%). Discussion. Our study confirmed the high level of safety of MCC vaccine in Tuscany: AEs proved rare and all cases had only tem- porary and self-resolving consequences. As usually only the most severe suspected AEs are reported, the true proportion of AEs requiring hospitalization was most probably overestimated, and it is plausible that most of these cases were in fact only temporally related.