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The aim of this study was the quality of service evaluation of two different organizational ways in delivering infant vaccination according to a Regional Vaccination Plan. Eleven vaccination centres were selected in two Local Health Units (ASLs) belonging to the Regional Health Service of the Lazio Region, Italy. The services offering paediatric vaccinations for children under three years of age, delivered without an appointment (VACP) or with the need for an appointment (VACL), were investigated. The quality aspects under evaluation were communicational efficiency, organisational efficiency and comfort. Subjective data were collected from different stakeholders and involve the elicitation of best and worst feasible performance conditions for the ASLs when delivering VACP/VACL services. Objective data consists in the observation of current performances of the selected vaccination centres. Quality scorecards were obtained from the combination of all data. Benchmarking between VACP and VACL, i.e., two different organisational ways in delivering infant vaccination, can be performed as a result of the probabilistic meaning of the evaluated scores. An expert of vaccination services, i.e., a virtual combination of patients, doctors and nurses, claims the quality of service delivery of the ASLs under investigation with probability 78.03% and 69.67% for VACP and VACL, respectively. In other words, for short, the quality scores of the ASLs were 78.03% for VACP and 69.67% for VACL. Furthermore our results show how to practically improve the current service delivery. The QuaVaTAR approach can result in improvements of the quality of the ASLs for the two different ways of delivering paediatric vaccinations in a simple and intuitive way.

Background: A new measurement process based upon a well-defined mathematical model was applied to evaluate the quality of human papillomavirus (HPV) vaccination centers in 3 of 12 Local Health Units (ASLs) within the Lazio Region of Italy. The quality aspects considered for evaluation were communicational efficiency, organizational efficiency and comfort., Results: The overall maximum achievable value was 86.10%, while the HPV vaccination quality scores for ASL1, ASL2 and ASL3 were 73.07%, 71.08%, and 67.21%, respectively., Conclusions: With this new approach it is possible to represent the probabilistic reasoning of a stakeholder who evaluates the quality of a healthcare provider. All ASLs had margins for improvements and optimal quality results can be assessed in terms of better performance conditions, confirming the relationship between the resulting quality scores and HPV vaccination coverage., Methods: The measurement process was structured into three steps and involved four stakeholder categories: doctors, nurses, parents and vaccinated women. In Step 1, questionnaires were administered to collect different stakeholders' points of view (i.e., subjective data) that were elaborated to obtain the best and worst performance conditions when delivering a healthcare service. Step 2 of the process involved the gathering of performance data during the service delivery (i.e., objective data collection). Step 3 of the process involved the elaboration of all data: subjective data from step 1 are used to define a "standard" to test objective data from step 2. This entire process led to the creation of a set of scorecards. Benchmarking is presented as a result of the probabilistic meaning of the evaluated scores.

Hepatitis B virus (HBV) infection is a serious global public health problem. The infection may be transmitted through sexual intercourse, parenteral contact or from an infected mother to the baby at birth and, if contracted early in life, may lead to chronic liver disease, including cirrhosis and hepatocellular carcinoma. On the basis of the HBV carrier rate, the world can be divided in 3 regions of high, medium and low endemicity. The major concern is about high endemicity countries, where the most common route of infection remains vertical transmission from mother to child. Screening of all pregnant women and passive immunization with human hepatitis B immunoglobulin are not affordable for many developing countries. The infection rate can be reduced by modifying behavior, improving individual education, testing all blood donations, assuring asepsis in clinical practice and screening all pregnant women. However, availability of a safe and efficacious vaccine and adoption of appropriate immunization strategies are the most effective means to prevent HBV infection and its consequences. The unsolved problem for poorest countries, where the number of people currently infected is high, is the cost of the vaccine. A future challenge is to overcome the social and economic hurdles of maintaining and improving a prevention policy worldwide to reduce the global burden of the disease.

Hepatitis A is the most common form of acute viral hepatitis in the world. Major geographical differences in endemicity of hepatitis A are closely related to hygienic and sanitary conditions and other indicators of the level of socioeconomic development. The anti-hepatitis A virus (HAV) seroprevalence rate is presently decreasing in many parts of the world, but in less developed regions and in several developing countries, HAV infection is still very common in the first years of life and seroprevalence rates approach 100%. In areas of intermediate endemicity, the delay in the exposure to the virus has generated a huge number of susceptible adolescents and adults and significantly increased the average age at infection. As the severity of disease increases with age, this has led to outbreaks of hepatitis A. Several factors contribute to the decline of the infection rate, including rising socioeconomic levels, increased access to clean water and the availability of a hepatitis A vaccine that was developed in the 1990s. For populations with a high proportion of susceptible adults, implementing vaccination programs may be considered. In this report, we review available epidemiological data and implementation of vaccination strategies, particularly focusing on developing countries.

Introduction: Attitudes towards the pandemic were different across countries and cultures and confounding news caused some to question whether unnecessary alarm and public panic resulted. The aim of this study was to detect behavior, perception and worry about pandemic flu among undergraduate students considered a group at major risk to contract and spread the infection., Materials and Methods: In November 2009, during the pandemic peak in Italy, we conducted a survey about pandemic flu by means of anonymous multiple choice self-administered questionnaires among students, attending different courses at the Tor Vergata University in Rome. To investigate the relationship between the level of concern about H1N1v and the attitude to prevention the sample was divided in three groups based on the level of the declared worry., Results: Among the 436 students that answer the questionnaires a statistical correlation was found between the level of worry and the disposition to change habits and the will to undergo vaccination. Males were less worried than females and more students living outside Rome would accept the vaccine., Discussion and Conclusions: The results of the study, generally in agreement with those of similar research, confirmed the need to know the relationship between fear and attitude in order to organize effective preventive campaigns.

The significant reduction of the cases of tetanus in the years led to an increased perception of risk associated with vaccination, which, like any medical procedure, entails the possibility of adverse reactions. Although the reviews of the literature show that the tetanus vaccine is implicated as responsible for serious adverse events, the neurological complications associated with it are extremely rare, as confirmed also by the small number of cases reported in the literature. It's necessary that all events temporally associated with vaccination are properly investigated and brought to the attention of healthcare workers and citizens, in order to establish an early treatment, which in most cases leads to complete recovery.

Viral hepatitis A and B are serious public health problems all over the world. Effective prophylactic measures and improvement in the hygienic and sanitary conditions have considerably modified the diseases trend, characterized by high prevalence levels in developing countries. In this paper the epidemiology of hepatitis A and B is reviewed, focused on endemic areas, on the basis of data collected from local and international studies in order to evaluate prevention strategies for both local population and travelers.

Definition, categorization, and measuring of Quality have become increasingly important concerns in the era of managed care and cost containment. Most attempts to develop quality indicators have been based on outcome measures. The Donabedian model of Structure-Process-Outcome has been universally accepted and used as the basis for much of the work addressing quality and outcomes. Adequate indicators for vaccination services are scant therefore are applied to this setting a new quality measurement process based on a probabilistic approach called MQS (Misure di Qualità in Sanità-Quality Measures in Healthcare), developed by our working group since 2005 in several hospital settings. This new application, called "Quality in Vaccination Theory and Research"(QuaVaTAR), was used to measure the efficiency of the vaccination centers of three Local Health Units (ASL RM B, RM F, RM H) in Lazio Region (Italy). The measure method combines the evidences obtained from the supplied services (objective measurements) and the judgments of the services' stakeholders collected by an "ad hoc" questionnaire (subjective measurements). The subjective evaluations were expressed with a number (between 0-100) representing a personal judgment on the organizational and the communicational efficiency and the comfort of the "ideal" vaccination center. The objective measurements were collected in performance grids on the same points investigated with the questionnaire. Combining objective and subjective measures we obtained "Quality Scores", useful to make improvements in the vaccination centers and to compare different services.

Human papilloma virus (HPV) is one of the most common sexually transmitted infections. The vaccine has the maximum benefit when given before starting sexual activity and its efficacy is proved also in sexually active women in which the incidence of the infection is higher. In 2010 a questionnaire on HPV was administered to 299 female students of University of Rome Tor Vergata. The results compared with those obtained in a similar 2007-08 survey, and with international data, showed that knowledge about HPV is still low, with a negative impact on the acceptance of specific preventive measures.

Foreign citizens living in Italy with residence permit represent about 7,2% of the population even if the international migration started recently in the Country. Sanitary problems of children and families whose lifestyle and disease awareness strongly differ from the typical approach of the industrialized world are important also in the acceptance of the immuneprophylaxis. This aspect has to be taken in account when considering the integration of vaccination schedules. Public Health Services will be able to respond adequately to the health demand only identifying the need of foreign children and offering them the appropriate intervention.

The decrease in the incidence of infectious diseases caused by vaccination is responsible for the huge importance given to adverse reactions from both population and health care personnel. Generally no real relationship exists between the true risks associated with vaccines and the risk perceived by the population. This aspect is confirmed by the results of a survey performed in 2009 among 376 students of the University of Roma Tor Vergata and 84 health care workers of the vaccination centers in Lazio Region.

The susceptibility to Hepatitis A virus infection is growing among the European population and many hepatitis outbreaks have been described in 2004-2008. The change in epidemiological characteristics observed in the last decades has to be taken in account in issuing specific recommendations about the use of the vaccine in pre and post exposure prophylaxis.

Combined vaccines and simultaneous administration are widely studied due to the increasing number of antigens available for newborns immunization. By means of simultaneous administration and combination of vaccines, an effective preventive strategy can be adopted, in order to obtain parents compliance and an optimal coverage of the target population.